Assessment of Subclinical Inflammation in Patients with Inflammatory Bowel Disease who use Cannabis

The plant Cannabis sativa, also known as marijuana or cannabis, has had both recreational and medicinal uses for centuries. Research into the effects of cannabis across a wide array of medical conditions has been increasing over the last few years, yet the data remains inconsistent. Despite this, individual state laws have allowed for the medical use of cannabis in 24 states. The medical use of cannabis is rising exponentially as patients become more attracted to complementary and alternative methods of treatment for their inflammatory bowel disease (IBD). However, to date, only a few studies have looked at the use of cannabis in patients with IBD. One particular study looked at use of complimentary alternative medicine (CAM) in over 200 Spanish patients with IBD and found that about 10% of patients with IBD use recreational drugs (including cannabis). There is limited data assessing the therapeutic efficacy of cannabis on objective markers of intestinal inflammation in IBD. Numerous studies have revealed that clinical symptoms do not correlate with CRP and that “deep remission”, defined as symptomatic and objective remission, is associated with improved clinical outcomes when compared to symptomatic remission alone.9,10 In an age where the focus of management has shifted away from a philosophy of symptomatic relief to one that includes mucosal healing and resolution intestinal inflammation, it is imperative that we assess for objective markers of treatment efficacy in any and all therapeutic interventions. To address this question, we designed a study to compare objective markers of intestinal inflammation between patients with IBD in symptomatic remission who use cannabis and those who do not. This hypothesis generating study will help shed light on whether cannabis has objective therapeutic benefit or if it merely masks symptoms without affecting intestinal inflammation. Individuals with IBD who are in clinical remission and use cannabis grater than 3x/week will have higher markers of subclinical inflammation, as measured by CRP and fecal calprotectin, when compared to individual with IBD who are in clinical remission and do not use cannabis. We will compare the proportion of patients with subclinical inflammation (as measured by a positive CRP) among individuals with IBD in remission who use cannabis and those who do not. We will perform bivariate analyses comparing the CRP and FC among individuals with IBD in remission who use cannabis and those who do not. AIM 2: We will perform multivariable analysis to determine whether there is a dose response between the degree of subclinical inflammation and the frequency of cannabis.