German IBD patients using cannabis reported benefits but most obtained it from the black market | Research

The takeaway

Among 417 German IBD patients surveyed, 4.3% currently used cannabis for their condition, reporting benefits like reduced pain and improved sleep, but 52.9% obtained cannabis from the black market and users had lower quality of life and more anxiety/depression than non-users.

Gastroenterologists, IBD patients, and policy makers interested in medical cannabis access patterns.

52.9% of cannabis-using IBD patients obtained it from the black market

What the researchers found

17.5% had used cannabis recreationally; 4.3% currently used cannabis to treat IBD. Users reported reduced abdominal pain, improved sleep, and relief of anxiety. However, users had lower quality of life and more anxiety/depression than non-users. 52.9% obtained cannabis from the black market. 76.5% of former and 50% of current users did not report cannabis use to their physician.

Why it matters

Even in Germany, where medical cannabis is available by prescription, more than half of IBD patients using cannabis obtain it from unregulated sources. The physician communication gap is also striking, mirroring findings from other countries.

The numbers in context

417 respondents; 4.3% current medical use; 17.5% recreational history; 52.9% black market; 76.5% former users and 50% current users did not tell physician

How the study worked

Cross-sectional survey mailed to a randomly selected representative sample of 1,000 IBD patients in Germany, with 417 responses (55.8% women; 43.4% ulcerative colitis, 54.7% Crohn's disease).

What this study cannot tell us

Response rate of 41.7% may introduce selection bias. Self-reported data. Cross-sectional design. German healthcare context may not generalize.

How to read the evidence

Representative random sample with reasonable response rate, though cross-sectional self-report design.

When this study was published

Published in 2021.

The bigger picture

The finding that cannabis users had lower quality of life and more anxiety/depression than non-users raises the chicken-and-egg question: are sicker patients turning to cannabis, or does cannabis use worsen outcomes? The black market procurement is a quality and safety concern.

Questions still open

Why do patients use the black market when medical cannabis is legally available in Germany? Would physician-guided cannabis use produce better outcomes than self-directed use? Are patients with more severe disease more likely to try cannabis?

Common questions

Do IBD patients find cannabis helpful?

Users reported reduced abdominal pain, improved sleep, and less anxiety. However, cannabis users overall had lower quality of life and more anxiety/depression than non-users, making it hard to separate cause from effect.

Do patients tell their doctors about cannabis use?

No, often not. 76.5% of former and 50% of current cannabis users in this German IBD sample did not disclose use to their physician.

Read the original research

Cannabis use of patients with inflammatory bowel disease in Germany: a cross-sectional survey.

Zeitschrift fur Gastroenterologie, 59(10), 1068-1077

View on PubMed ↗Publisher’s paper ↗

Citation

Neufeld, Tanja; Pfuhlmann, Katrin; Stock-Schröer, Beate; Kairey, Lana; Bauer, Nina; Häuser, Winfried; Langhorst, Jost. (2021). Cannabis use of patients with inflammatory bowel disease in Germany: a cross-sectional survey.. Zeitschrift fur Gastroenterologie, 59(10), 1068-1077. https://doi.org/10.1055/a-1400-2768