Most IBD patients using marijuana reported benefits but also had worse symptoms and mental health than non-users | Research

The takeaway

A survey of 1,666 IBD patients in legal-access states found that only 4.4% used prescription marijuana and 12.8% had asked their doctor about it, while users reported high perceived benefits (80.7%) but also more depression, anxiety, and pain than non-users.

Gastroenterologists managing IBD patients; medical cannabis patients with IBD; researchers studying patient-reported cannabis outcomes.

80.7% of IBD marijuana users reported benefits, but only 12.8% had discussed it with their doctor

What the researchers found

Researchers surveyed 2,357 inflammatory bowel disease patients living in states where marijuana was legal, with 1,666 (71%) completing the survey.

Only 214 patients (12.8%) had asked their doctor about marijuana use, and just 73 (4.4%) used prescription marijuana.

Among 234 patients living where both medical and recreational marijuana was legal, 49 (20.9%) reported using recreational marijuana specifically for IBD.

Marijuana users reported high perceived benefits (80.7%). However, users also reported more depression, anxiety, pain interference, and lower social satisfaction than non-users.

Patients on prescription marijuana had more active disease and greater use of steroids, narcotics, and the sleep aid zolpidem, suggesting marijuana use was concentrated among those with harder-to-treat disease.

Why it matters

This study reveals a common pattern in medical cannabis use: patients who use it tend to be sicker and more symptomatic, which complicates the interpretation of both perceived benefits and associated harms. The low rate of physician consultation (12.8%) suggests a disconnect between patient cannabis use and clinical care.

The numbers in context

1,666 respondents (71% response rate). 12.8% asked their doctor about marijuana. 4.4% used prescription marijuana. 20.9% recreational use in dual-legal states. 80.7% of users reported benefits. Users had more depression, anxiety, pain interference, and lower social satisfaction.

How the study worked

Cross-sectional internet-based survey through the CCFA Partners cohort. Surveyed IBD patients in states with legal marijuana access. Bivariate statistics and logistic regression to identify factors associated with marijuana use.

What this study cannot tell us

Cross-sectional design cannot determine whether cannabis helped, hurt, or had no effect on symptoms. Self-selected internet cohort may not represent all IBD patients. Self-reported cannabis use and perceived benefits are subject to recall and desirability bias.

How to read the evidence

Moderate. Large survey through an established IBD cohort, but cross-sectional design and self-report limitations prevent causal conclusions.

When this study was published

Published in 2018. Medical cannabis use among IBD patients has likely increased as legalization has expanded.

The bigger picture

The finding that marijuana users perceive benefits while also having worse symptoms likely reflects a selection effect: patients with the most difficult-to-manage IBD are more likely to try cannabis. This does not mean cannabis worsens symptoms, but it does mean the patient population using cannabis has greater disease burden.

Questions still open

Would controlled trials show cannabis actually improves IBD symptoms, or do users just perceive benefits due to psychoactive effects? Why are so few patients discussing marijuana with their doctors? Would physician-guided cannabis use improve outcomes?

Common questions

Does marijuana help with inflammatory bowel disease?

In this survey, 80.7% of users reported perceived benefits. However, users also had more symptoms and worse mental health than non-users, suggesting those with harder-to-manage disease are more likely to try cannabis. Controlled trials are needed to determine whether cannabis actually improves IBD outcomes.

Why did so few patients ask their doctor about marijuana?

Only 12.8% of respondents had asked their doctor about marijuana use for IBD. This may reflect stigma, concern about physician judgment, uncertainty about legality, or a belief that conventional medicine has nothing to offer on the topic. This gap between patient use and physician awareness is a common finding across medical cannabis research.

Read the original research

Profiles of Patients Who Use Marijuana for Inflammatory Bowel Disease.

Digestive diseases and sciences, 63(6), 1600-1604

View on PubMed ↗Publisher’s paper ↗

Citation

Kerlin, Ann Marie; Long, Millie; Kappelman, Michael; Martin, Christopher; Sandler, Robert S. (2018). Profiles of Patients Who Use Marijuana for Inflammatory Bowel Disease.. Digestive diseases and sciences, 63(6), 1600-1604. https://doi.org/10.1007/s10620-018-5040-5