Many Australians with IBD use cannabis for symptom management – but their doctors aren’t convinced
Two recently published surveys on inflammatory bowel disease (IBD) and medicinal cannabis use – one of patients and one of gastroenterologists – conducted by the University of Sydney’s Lambert Initiative for Cannabinoid Therapeutics in partnership with prominent Australian IBD specialists, shine a new light on the potential for medicinal cannabis to manage symptoms of IBD, namely Crohn’s Disease and Ulcerative Colitis.
The IBD patient survey was published in April 2020 in Crohn’s and Colitis 360. This anonymous online survey of 838 Australians living with IBD explored their use of, and attitudes towards, medicinal cannabis.
Current therapeutic options for IBD frequently leave patients with poor control over their symptoms and as a result they seek alternative treatment options like medicinal cannabis. The widespread community interest in cannabis for IBD arises from existing surveys, anecdotal reports of efficacy within the IBD community, some limited previous clinical trials, and reports of improvements in disorders with similar symptoms.
IBD patients were recruited through advertisements on Australian IBD consumer networks, University websites, social media platforms, and by word-of-mouth. IBD patients were asked a series of 82 questions, comprising 7 IBD-specific questionnaires, as well as questions about their current and historical cannabis use.
25% of respondents had used cannabis to treat their IBD symptoms
A total of 212 respondents reported using cannabis to treat their IBD symptoms at some point in time, of which 60 respondents were past users, and 152 respondents are present users.
Medicinal cannabis is currently legal in Australia for medical use on prescription. However, only three respondents reported using a prescribed cannabis medicine, meaning that almost all IBD patients surveyed were using unregulated, illicit products. Most people got their cannabis from a recreational dealer (44.6%), and used a joint or bong to smoke their cannabis (46.7%).
IBD patients using cannabis are less likely to engage in mainstream therapies
People who reported current or past medicinal cannabis use were significantly more likely than non-medicinal cannabis users to:
- Be male (1.7 times as likely)
- Not be under the care of an IBD specialist (2.4 times as likely)
- Not be taking pharmaceutical treatments for IBD (2 times as likely)
- Have been hospitalised for their IBD (1.6 times as likely)
- Have been hospitalised >10 times in their life for IBD (1.7 times as likely)
This suggests that people who are less likely to engage in mainstream clinical therapies for the treatment of IBD are more likely to be using cannabis for medical purposes. The reasons for this are complex. There is the possibility that less engagement with specialists and pharmaceutical treatments is behind increased hospitalisation and use of alternatives such as cannabis. On the other hand, it is also possible the patients using cannabis for IBD management have more refractory disease
People who currently use cannabis to treat IBD symptoms report that cannabis helps them a lot
An overwhelming 97% of all medicinal cannabis users endorsed cannabis as effective in symptom management. Current users reported that cannabis helps them manage their abdominal pain, stress, and sleep. Here is how they rated the impact of cannabis use on their symptoms:
* Taken from Benson et al. “Medicinal Cannabis for Inflammatory Bowel Disease: A Survey of Perspectives, Experiences, and Current Use in Australian Patients.” Crohn’s & Colitis 360 2.2 (2020): otaa015.
The IBD survey for specialist gastroenterologists was published in June 2020. It was the first of its kind to explore clinician attitudes towards MC use in IBD patients.
70 specialist doctors and 23 medical students in their final 3 years of gastroenterology training were surveyed about their knowledge of and attitudes towards the use of medical cannabis to treat IBD symptoms. Respondents completed a 30-question survey about their patients’ use of mainstream and complementary therapies, including cannabis.
Half of all respondents reported at least one patient in the past 3 months had asked them about medical cannabis to treat their IBD symptoms. And 39% of respondents had at least one patient who was currently using cannabis for symptomatic relief.
Most doctors are open to complementary therapies in general
48% of surveyed clinicians supported the use of complementary therapies, and 27% were neutral towards them. When asked about their patients’ success in managing symptoms with specific alternative therapies, the clinicians noted dieting (77%); stress management (72%) and pre/probiotics (55%) were most successful. A far lower percentage of surveyed clinicians endorsed cannabis as having been effective for their patients (27%).
Few doctors believe cannabis can treat IBD symptoms
Of all surveyed clinicians, 21.1% were supportive of the use of medical cannabis in IBD patients, with a similarly low percentage expressing a desire to prescribe it. Most clinicians (42.2%) were neutral and many others (36.7%) were opposed to the use of medicinal cannabis all together.
Why is this the case? Consistent with previous studies of General Practitioners, the vast majority of respondents were not comfortable or were neutral about discussing medical cannabis with their patients. This is consistent with only 15.6% of surveyed gastroenterological specialists agreeing that there is sufficient evidence of the efficacy of cannabis for IBD symptoms.
In a previous study of General Practitioners, with data collected in 2017 (less than a year after Australia’s medical cannabis scheme was implemented), only 6.9% of respondents reported they knew how to legally facilitate access to medical cannabis for their patients. Concerningly, a similar proportion of specialist gastroenterologists – only 5.6% – reported they knew how to help patients legally access medical cannabis.
This is despite the IBD survey being conducted in 2019, three years after the legalisation of medical cannabis in Australia, and despite the fact that half of the IBD specialists surveyed reported that patients had asked them about medical cannabis in the last three months. This suggests that much more work needs to be done to educate doctors in all specialties, not just about the clinical consideration of prescribing medical cannabis, but also the bureaucratic processes necessary to facilitate access.
As Australian IBD patients continue to use MC to manage their IBD, more needs to be done to facilitate appropriate, legal medicinal use. Of crucial importance are more, quality, larger clinical trials to properly investigate the efficacy and safety of cannabis medicines in the management of IBD. Encouragingly, more than half of the surveyed clinicians reported they would encourage their patients to participate in future trials of medical cannabis and IBD.
* Figure taken from Benson et al. “Attitudes and knowledge of Australian gastroenterologists around use of medicinal cannabis for inflammatory bowel disease.” Crohn’s & Colitis 360 (2020).