BY KASANDRA BRABAW
While cannabis may seem like a miracle drug that can treat a myriad of health conditions from migraines to cancer, the plant can’t be used to treat everything. So, you may be asking whether or not cannabis is an option for you. If you live in one of the 33 states that have legalized medical marijuana, you’re able to ask your doctor about using it. And if you have Crohn’s disease, the answer to whether cannabis may help will almost certainly be yes.
Although each state has different qualifying conditions, most of the states that allow medical marijuana consider Crohn’s disease an acceptable reason to have a prescription. Even some states that haven’t explicitly listed Crohn’s as a qualifying condition may allow Crohn’s patients to use cannabis as part of their treatment plan, because Crohn’s often causes the kind of chronic nausea and pain that constitutes a qualifying condition.
If your state allows medical marijuana for Crohn’s disease, the first step is talking to your gastroenterologist. While it may feel strange talking to a doctor about marijuana, many are open to your using it as part of a larger plan to combat the condition. Alyssa Parian, MD, a gastroenterologist at Johns Hopkins Bayview Medical Center, says that roughly half of her patients ask about using marijuana. “I’m not opposed to them using it,” she says. In some cases, marijuana may be better than the narcotics her patients would otherwise use to treat chronic pain caused by Crohn’s disease, she says. But she does tell her patients that, like anything else in life, marijuana should be used in moderation. “Nothing is without side effects,” Parian says.
That said, she knows (and scientific studies have proven) that cannabis can be helpful for treating some symptoms of Crohn’s disease, specifically pain, nausea, and lack of appetite. And some of her patients also say it helps with their diarrhea, at least slightly.
But the biggest question right now is whether medical marijuana simply treats the symptoms of Crohn’s disease (acting like a kind of Band-Aid), or if it actually helps to treat the root cause of the disease: inflammation in the bowels. “There are studies right now looking at whether it actually helps the inflammation or not,” Dr. Parian says. “We’re waiting for some real, ongoing studies to publish [that] data.”
Until the research results are available, she can’t recommend that patients tamp down any of their traditional medications (except possibly reducing usage of narcotic painkillers) to add marijuana to the mix. “What I tell my patients right now, is that I’m not opposed to them using [cannabis], but I’d prefer they don’t use it every day, and instead use it [to manage] their symptoms as needed,” she says.
She also warns her patients of the consequences. In one study of patients with inflammatory bowel diseases, frequent cannabis use was associated with an increased risk of surgery. “What we think is happening is that patients are using it and masking their symptoms, or they’re using more and more of it and not seeing their doctor,” Parian says. Then, these patients aren’t feeling that their Crohn’s symptoms are getting worse, and are not getting the medical attention they need.
Because of issues like this, Parian urges her patients who ask about medical marijuana not to stop their medical therapy or view the plant as a full-fledged replacement, but to use cannabis as a supplemental medication. And if you keep experiencing pain and vomiting, make sure to talk to your doctors rather than take more cannabis to mask the pain.
Then, once they’ve gone through these conversations and the patient is still interested in trying medical marijuana, Parian has to hand them off: At the hospital where she works, she’s not allowed to issue medical marijuana cards, so her next step is a referral to a doctor who can write them that prescription—a doctor like Oliver Park, MD, a medical marijuana doctor who practices in Brooklyn, NY.
Park sees many patients who have all kinds of conditions, and he counsels them on using marijuana as part of their treatment plan. During the first visit, he typically reviews the patient’s medical history and does a physical exam, if necessary. Then, he and the patient will sit down for a chat about how medical marijuana could help them, and how to get started. “For Crohn's disease and other inflammatory bowel conditions (such as Ulcerative Colitis), I do recommend that the patient start with a good balance of THC and CBD,” he says.
Medical marijuana dispensaries don’t always give out the whole plant—neither smokable nor edible versions are allowed in New York, for instance. Instead, Park suggests opting for something like a tincture, which people can use by dropping small amounts of CBD or THC oil into their mouths. It’s much easier to control how much you’re using that way, Parian says, and you’re less likely that you’ll harm your lungs than if you were to smoke the plant.
Park suggests beginning with small amounts. He recommends a one-to-one ratio to start, usually about five to 10 milligrams total (THC and CBD combined). Then, you can slowly try larger amounts of either THC or CBD to see what works best for your symptoms.
Crohn’s patients will likely always find it helpful to use both CBD and THC. “The gastrointestinal system contains a vast quantity of receptors that are acted upon by THC and CBD,” Park says, noting that both cannabinoids have been shown scientifically to help decrease Crohn’s symptoms. Parian says her patients usually find that a high CBD, low THC mix works best for them. That said, each person will respond to a different ratio and a different dose, so you may mind that your ratio is slightly different.
Ultimately, you can’t truly start to figure out what’s best for you until you reach out to your doctor. So bite the bullet and make an appointment—once you get the conversation going, you’ll be on your way to getting a medical marijuana card and soothing your symptoms. And when you’re ready, you can shop MedMen for all your needs.