Cannabis linked to decreased pain in colitis patients - study

A worker touches a cannabis plant at a growing facility for the Tikun Olam company near the northern city of Safed
(photo credit: REUTERS/NIR ELIAS)

Those who haven't responded positively to accepted treatments have long been turning to medical cannabis for symptomatic relief.

Ninety percent of patients who suffer from ulcerative colitis reported decreased stomach pain after using medical cannabis, after failing to see improvement using conventional medicines, according to a new study by Israeli medical cannabis giant Tikun Olam.
Ulcerative colitis (UC) is a chronic, inflammatory colon condition similar to Crohn’s disease.
The double-blind, randomized, placebo-controlled study was published last month in PLOS One, a peer-reviewed, open-access scientific journal. Doctors at Meir Medical Center in Kfar Saba tested 32 colitis patients who had all failed to respond to previously prescribed treatments.
While currently prescribed treatments for colitis can cause the disease to go into remission in around 50%-60% of patients, those who have not responded positively to accepted treatments have long been turning to medical cannabis for symptomatic relief.
When medical cannabis was first approved in Israel’s health basket more than 15 years ago, Inflammatory bowel disease (IBD) – an umbrella term for chronic disorders, which includes ulcerative colitis – became one of the first disease types which were approved for treatment of patients with a prescription for medical cannabis.
The study also found that 62% of respondents saw an improvement in bowel activity, 54% saw a decrease in disease severity, and 27% experienced an increase in “life quality” when compared to the placebo group.
For the placebo group to remain unaware of their placebo status, they were given joints (cannabis cigarettes) filled with cannabis that had the active ingredients taken out of it. The rest were given a gram per day of pure joints filled with 16% THC medical cannabis from Tikun Olam’s signature Erez strain.
The study found that patients who were treated with the Erez strain reported improved appetite and focus, increased sex drive and a decrease in pain.
According to the Crohn’s and Colitis Foundation, there are currently around 10 million people who suffer from chronic digestive diseases worldwide, including about 50,000 in Israel.
People who suffer from UC have several liquid bowel movements a day and are often unable to work in professions or go to areas without proper access to bathrooms.
“Someone who suffers from a serious case of colitis will often have a spare piece of underwear in their bag,” Lihi Bar-Lev Schleider, head of research and development at Tikun Olam, told The Jerusalem Post on Monday.
“It causes patients to have to avoid parties, avoid long flights and public transportation and avoid any prolonged social event where they wouldn’t have immediate access to a bathroom if necessary,” she said. “It harms the quality of life drastically.” 
THE STUDY was led by Dr. Timna Naftali at Meir Medical Center’s gastroenterology ward along with Schleider.
Schleider said she chose to study the Erez strain due to its strength and its observed symptomatic compatibility with ulcerative colitis.
“The main symptoms that define [UC] patients are, on the one hand, a very intense pain and, on the other hand, nausea and a loss of appetite,” she said.
“Erez has a few specific strengths, namely, an improved appetite and a reduction of both pain and nausea,” she added. “It was a symptomatic bingo.”
Based on colonoscopies that each patient had before and after the trial, the study found a marked improvement in clinical disease severity between the cannabis group and the placebo group, with some of the treated patients even going into remission.
However, the study’s small sample size and relatively short time frame make it insufficient to prove a link between endoscopic remission and medical cannabis.
“One of the reasons it took us so long to find patients who were willing to volunteer was the colonoscopy requirement,” Schleider said. “Asking people to do two colonoscopies in such a short time frame wasn’t easy.”
If the study had even a slightly larger participant base, featuring the same average endoscopic results, it would have proven a pronounced link between endoscopic remission and medical cannabis, she said.
If the same study had continued for longer than eight weeks, then it would also have proven a pronounced link, she added.
“Seventeen of the study participants continued using medical cannabis and reported results to the hospital for an additional year after the study... We found their endoscopic scores drop dramatically over time,” Schleider said.
“The problem is that the [yearlong] study doesn’t have a placebo group,” she said. “It would be unethical to keep someone using a placebo for an entire year while they have a condition like this.”
Schleider received her Master of Arts in Psychobiology at the Tel Aviv University and is now finishing her PhD in epidemiology, with a focus on cannabis, at the clinical research center in Soroka Medical Center and Ben Gurion University, under the guidance of Prof. Raphael Mechoulam – also known as the godfather of cannabis research – and Prof. Victor Novack, who heads the coronavirus ward at Soroka.

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