IBD patients who self-medicated with cannabis showed more depression, impulsivity, and substance misuse risk | Research

The takeaway

Among 201 IBD patients, those using cannabis to manage symptoms showed higher impulsivity, more depressive symptoms, and were 4 times more likely to be high in impulsivity than recreational cannabis users, flagging substance misuse vulnerability.

Gastroenterologists, addiction medicine specialists, and IBD patients considering cannabis.

4x more likely to self-medicate if high in impulsivity

What the researchers found

IBD patients self-medicating with cannabis were more likely to use cannabis for coping (p=0.016), demonstrated higher impulsivity (p=0.004), and had more depressive symptoms (p=0.012) compared to recreational users. Smokers, those with moderate-severe depression, and those high in impulsivity were each about 4 times more likely to use cannabis for IBD symptoms.

Why it matters

As medical cannabis is increasingly considered for IBD, this study highlights that patients self-selecting cannabis treatment may have characteristics that increase their vulnerability to substance misuse.

The numbers in context

201 IBD patients, 108 with lifetime cannabis use. Crohn's patients more likely to use for symptoms (53%) vs UC (28%). Self-medicators: 4.1x more likely to smoke tobacco, 3.7x more likely to have moderate-severe depression, 4.1x more likely to be high in impulsivity.

How the study worked

Cross-sectional survey of 201 IBD patients examining cannabis use patterns, mental health symptoms, and personality risk factors for substance misuse. Compared individuals using cannabis for IBD management versus recreational use.

What this study cannot tell us

Cross-sectional design cannot determine if cannabis use caused or resulted from the observed mental health patterns. Self-report measures may not capture full picture. The sample may not represent all IBD patients.

How to read the evidence

Moderate: adequate sample with validated psychological measures, though cross-sectional and limited to self-report.

When this study was published

Published in 2020 in Inflammatory Bowel Diseases.

The bigger picture

The findings suggest that screening for mental health comorbidities and substance misuse vulnerability should be standard practice before recommending or prescribing cannabis for IBD, rather than simply assuming medical use is inherently low-risk.

Questions still open

Should IBD treatment guidelines include mental health screening before cannabis recommendations? Do the patients self-medicating with cannabis achieve better symptom control despite their higher risk profile?

Common questions

Does this mean cannabis is bad for IBD patients?

Not necessarily. The study found that patients who chose to self-medicate had more risk factors for substance misuse, not that cannabis itself caused harm. It suggests screening is important, not that cannabis should be avoided entirely.

Why were Crohn's patients more likely to self-medicate?

A higher proportion of Crohn's disease patients (53%) used cannabis for symptom management compared to those with ulcerative colitis (28%). Crohn's disease may cause more pain and symptoms that lead patients to seek additional relief.

Read the original research

Cannabis Use in Persons With Inflammatory Bowel Disease and Vulnerability to Substance Misuse.

Inflammatory bowel diseases, 26(9), 1401-1406

View on PubMed ↗Publisher’s paper ↗

Citation

Hansen, Tawnya M; Sabourin, Brigitte C; Oketola, Banke; Bernstein, Charles N; Singh, Harminder; Targownik, Laura E. (2020). Cannabis Use in Persons With Inflammatory Bowel Disease and Vulnerability to Substance Misuse.. Inflammatory bowel diseases, 26(9), 1401-1406. https://doi.org/10.1093/ibd/izz272