Many patients with certain Chronic
Diseases or Injury are dissatisfied with mainstream choices of pharmaceutical treatments. This is in large part to ineffective relief from symptoms, drug toxicity, and/or unacceptable side effects. These patients may turn toward a less conventional treatment regimen, for some this includes Medicinal Marijuana (MM). MM has been used as to treat multiple diseases and conditions, including: Anorexia, Asthma, Crohn's Disease (CD)
, Diarrhea, Glaucoma, Multiple Sclerosis (MS), Nausea / Vomiting, Pain (especially Chronic Pain), Rheumatoid Arthritis (RA), Spinal Cord Injury, Ulcerative Colitis (UC)
, etc. The smoked form of Marijuana has a Psychoactive component as well. Some persons view the Psychoactive effects of Marijuana as a desirable effect, while others feel they are negative.
Disclaimer: There are legal issues with Medicinal Marijuana (MM) use in some areas. Please ensure MM is legal in your area, including purchase, transport and consumption, prior to treatment. As always, only make changes to your medicines under the advice and supervision of your physician.
The plant, Cannabis sp.
, is also known as Marijuana or Medicinal Marijuana (MM). The main body of research regarding Medicinal Marijuana or Hashish is focused on the Cannabinoids, including, Delta-9-TetraHydroCannabinol (THC) or Cannabidiol (CBD). However, the Marijuana plant contains many additional Cannabinoids for which research data are limited.
Treatment with Medicinal Marijuana or other Cannabinoid based treatments are generally well tolerated with mild side effects.
Phytocannabanoids, or plant-based Cannabinoids, are produced by certain species of plant. The Cannabinoid can be extracted from the plant or ingested directly. Typically, plants cultivated for Cannabanoid use include:
Cannabis sativa Linnaeus or Cannabis sativa L.
Cannabis plants can be male, female or hermaphroditic (both male and female). Unfertilized female plants produce the highest levels of Cannabinoids while Male plants are used mainly to fertilize female plants and produce seeds. Different species, subspecies and strains of Cannabis can interbreed, producing "hybrids" with desirable traits.
Cannabis indica generally have a higher level of THC, and ratio of THC to CBD. Certain strains of Cannabis indica also contain higher levels of the Cannabinoids, CannaBiDiVarin (CBDV) and/or TetraHydroCannabiVarin (THCV), while Cannabis sativa L. in general does not.
The body produces substances called Endocannabinoids or Endogenous Cannabinoids, which function in a similar manner to Cannabinoids found in Medicinal Marijuana. Two heavily studied Endocannabinoids include Anadamide and 2-ArachidonylGlycerol (2-AG). Anadamide and 2-AG are specialized fats that act as signaling messengers. Their "signal" is transmitted through their corresponding "signal receiving units", or Cannabinoid Receptors (CB).
Cannabinoids, IBS and IBD
Cannabinoids, either produced within the body or taken from an external source (Pharmaceutical or Medicinal Marijuana), exert effects that may be of benefit to patients with Irritable Bowel Syndrome (IBS) and certain types of Inflammatory Bowel Disease (IBD)
, including Crohn's Disease
and Ulcerative Colitis
. Medicinal Marijuana affects Cannabinoid Receptors (CB) in the Gastrointestinal Tract and can exert effects that help relieve symptoms. These effects include a reduction of: Pain, Inflammation, Diarrhea, Gastrointestinal Hypermotility and Secretion. Cannabis can reduce painful Gastrointestinal cramping as it is a smooth muscle relaxant, and can relax the Intestinal spasms. Cannabinoids can also increase healing of injured Epithelial Tissues. Many of these effects are due to Cannabinoid stimulation of Cannabinoid Receptors (CB) located in many parts of the body.
Cannabinoid Receptors (CB)
Cannabinoids, either Endocannabinoids or Cannabinoids from an external source (ex. Medical Marijuana), mainly exert their effects on the body via the Cannabinoid Receptors (CB), Cannabinoid Receptor 1 (CB1) and Cannabinoid Receptor 2 (CB2). CB1 and CB2 are distributed in different areas of the body. CB1 is found in many regions of the body, including in the brain and digestive tract.
The Cannabinoid Receptor 1 (CB1) is widely present throughout the body, including the Brain and Enteric Neurons.
Signaling through CB1 has potent effects that may be beneficial to persons with IBD, including: reduction of Nausea/Vomiting, inhibition of Intestinal Motility, and anti-Inflammatory effects. There is an effort being made by pharmaceutical companies to design medications that increase signaling through CB1. These medications may offer effective treatment for Inflammatory Bowel Diseases (IBD)
including Crohn's Disease
and Ulcerative Colitis
. CB1 is present in the Brain and is responsible for the Psychological and Behavioral effects seen with use of Medicinal Marijuana. In order to be an effective treatment and minimize psychological effects seen with Medical Marijuana use, the pharmaceutical should be specific for CB1 and not cross the Blood Brain Barrier (BBB).
CB1 appears to protect against severe Colitis. Studies in mice that have CB1 blocked or do not have CB1 (CB1 knockout mice) develop more severe experimental colitis symptoms than Wild Type
In animal models of Colitis, pretreatment with CB1 agonists (chemicals that activate the Receptor) leads to reduced chemical-induced Inflammation and Edema
than animals not given pretreatment medication.
Anandamide is a CB1 agonist produced by the body and has anti-Inflammatory properties. Signaling through CB1 can also be increased by reducing the activity of the enzyme responsible for Anandamide breakdown, Fatty Acid Amidohydrolase (FAAH). FAAH inhibition (reducing Anandamide breakdown), causes increased Anandamide levels and corresponding increased CB1 signaling.
Targeted inhibition of FAAH is currently being investigated as a potential therapy for IBD and other Inflammatory diseases.
Further evidence for the role of CB1 on Gastrointestinal Health is shown with chemicals that block signaling through CB1 (Receptor Antagonists). For example, the Pharmaceutical agent Rimonabant (a CB1 antagonist), causes Diarrhea and Weight Loss.
In chemically induced experimental models of Intestinal Inflammation, both Anandamide and CB1 are increased.
This may be a mechanism for reducing pro-Inflammatory Gastrointestinal changes such as: GI Tract Hypermotility, Secretion and Diarrhea. Intestinal Inflammation also increases FAAH levels, the enzyme responsible for Anandamide breakdown 
and may be an added factor regulating the balance between Pro- and Anti-Inflammatory conditions in the GI Tract.
Cannabinoid Receptor 2 (CB2) is responsible for mediating many of the Immune System related effects on the human body. Some of these effects can be beneficial to persons with certain diseases, while others may be detrimental.
Cannabinoids have Anti-Inflammatory effects on the body and can cause reduction of the Cell-Mediated Immune Response in Chronic
users. The Humoral Immune response can be increased by Cannabinoids. The AntiInflammatory effects of CB2 signaling is thought to be a causal factor behind the effectiveness of Medicinal Marijuana in treatment of Inflammatory Diseases, such as: Crohn's Disease, Multiple Sclerosis and Rheumatoid Arthritis.
-induced intestinal Inflammation can induce an increase in GI Tract Motility. Signaling through CB2 (via CB2 agonists) can inhibit this increased GI Motility.
Types of Cannabinoid Treatment
There are multiple methods of Cannabinoid Treatment. Each method, depending on the preparation and mode of ingestion can have different Psychoactive, Analgesic and AntiInflammatory effects. Pharmaceutical companies offer purified preparations of THC, CBD or chemically generated Cannabanoid Receptor Agonists or Antagonists. Patients may also choose to smoke or otherwise ingest parts of the Cannabis sativa plant or oils.
One common complaint patients relay regarding purified pharmaceuticals or medications that specifically act at the Cannabanoid Receptor is a reduced effectiveness in comparison to the plant-based product. However, pharmaceuticals designed to act at CBs but that do not cross the Blood Brain Barrier (BBB) do not have the psychoactive effects common to plant-based treatments and plant-purified extracts.
Cannabis sativa contains many more chemicals which may be relevant to treatment effects than the commonly known active compounds, THC and CBD. It has been estimated that THC accounts for only 1/3 of Medicinal Marijuana's effects. (Fairbairn 1981) In addition, chemicals have been found in Cannabis sativa extracts which either Enhance the effects of THC or Inhibit it.
Some methods for Medicinal Marijuana treatment are described below:
Medicinal Marijuana / Smoked Cannabis / Cannabis sativa / Hash Oil
Controlled clinical studies using Medicinal Marijuana in patients with Neuropathic Pain
and Pain related to Human Immunodeficiency Virus (HIV) showed improvement in Pain Scores with no serious treatment related side effects.
plants extracted with different materials contain variable quantities of extracts that can inhibit THC or propagate its effects. Alcohol and Water based extracts contain greater levels of THC Inhibitors than organic extracts. Smoking Marijuana or Hash through water will dissolve the THC Inhibitors possibly potentiating the Psychoactive effects of the medication.
Some Medicinal Marijuana is ingested using a Vaporizer. Vaporizers heat Marijuana products to a high temperature, but below the temperature required for it to ignite. It is thought that using a Vaporizer can reduce smoke related side effects. This may be helpful for persons with respiratory diseases. 
Marinol R / Dronabinol
Marinol (Dronabinol), from Abbott Laboratories Inc., is a synthetically produced version of Delta-9-TetraHydroCannabinol (THC) in sesame oil. Dronabinol is formulated as a capsule for oral administration. Clinical studies using Marinol (Dronabinol) indicated a significant improvement in Pain related to Multiple Sclerosis (MS). Pain levels are significantly reduced in patients with Chronic Pain when Dronabinol is added concurrently with Opioid therapy.
Clinical trials using Nabilone exhibited significant improvement of Pain due to Fibromyalgia and Spasticity, Neuropathic Pain and Spinal Pain. Nabilone is also used to boost Appetite and reduce Nausea and Vomiting. A study comparing Nabilone with Dihydrocodeine showed pain symptoms improved with both medications, although Dihydrocodeine reduced pain scores slightly better than Nabilone. 
Oromucosal Cannabis Extracts
Oromucosal Cannabis Extracts have shown patients with Chronic and Neuropathic Pain exhibit reduced pain with treatment. A study with Rheumatoid Arthritis (RA) patients did not show improvement in Pain symptoms but did show a significant improvement in RA Disease Activity.
Clinical studies using Oromucosal Cannabis Extracts are mixed with regard to improvement in Pain Disability Index (PDI) scores. Significant improvement was seen in patients with Neuropathic Pain  but not in pain due to Brachial plexus avulsion.
Sativex / Nabiximols
Sativex, or Nabiximols, is an Oromucosal Cannabis extract Spray. It consists of Delta-9-TetraHydroCannabinol (THC) and Cannabidiol (CBD) in a 1:1 mixture for controlled dosing. Sativex has been used as a treatment for patients with Cancer, Multiple Sclerosis (MS), Neuropathic Pain and Spasticity due to benefits from each of the compounds. It can be used alone or as an additive to Opioid-based therapy.
Cannabidiol (CBD) has Anti-Anxiety, Anti-Convulsant, Antioxidant, Antipsychotic, Muscle Relaxant and Neuroprotective effects.
Delta-9-TetraHydroCannabinol (THC) has Analgesic (Pain Relief), Anti-Emetic (Relief from Nausea and Vomiting) and Muscle Relaxant properties. It is also increases Appetite and affects the Mind and Behavior (Psychoactive Properties).
THC-11-oic Acid Analogue / Ajulemic Acid
Ajulemic Acid (THC-11-oic Acid Analogue) was shown to improve symptoms in patients with Allodynia (inappropriate pain response to nonpainful stimulus), Hyperalgesia
, or Neuropathic Pain shortly after dosing (3 hours), but after 8 hours pain levels were similar to patients treated with Placebo (no drug).
Cannabinoids and Pain
In clinical trials, cannabinoids have been shown to be effective for treating pain, including Chronic
Pain. Overall, patients report a modest to significant improvement in level of pain, function, sleep and quality of life with Cannabinoid-based treatment. Improvement in pain levels has been shown using the following Cannabinoids:
- Cannabis Extracts 
- Dronabinol 
- Medicinal Marijuana (smoked) 
- Nabilone 
Effects of Cannabinoids on the Body
Addiction / Abuse of the drug
Cognition / Thought Impairment /Working Memory Impairment (Eggan 2010)
Increased Feeding Behavior (Eating)
Schizophrenia Risk Increased with Cannabis use (especially in early- or pre-teens) (Eggan 2010)
Nervous System Treatment
Analgesia / Pain Reduction
Motor / Movement Disorders / Dystonia
Multiple Sclerosis Symptoms
Cell-Mediated Immune Response Decreased
Humoral Immune Response Increased
Rheumatoid Arthritis Treatment
Negative Effects of Cannabinoid Treatment / Use
Cannabinoid use, including Marijuana, can cause negative side effects. These side effects are typically mild to moderate and do not usually cause patients to stop therapy. Many people experience Euphoria and difficulty with Thought, Short Term Memory (Working Memory), and Movement with Cannabinoid use. This can occur in any user age group. Some side effects are more pronounced or more likely to occur during specific age groups, in particular when the brain is undergoing active development or remodeling (mid teenage years or earlier). Babies born to mothers who use Cannabis during pregnancy have a greater risk of impaired development of certain brain areas, especially those responsible for thought function. In addition, there is an increased risk of Schizophrenia in pre- and early-teen Cannabis users.
Medicinal Marijuana use can cause high heart rate and low blood pressure. There is also an increased risk of heart attack within the first hour after marijuana smoking. The risk of heart attack after marijuana smoking is greater in people that also smoke cigarettes, are significantly overweight, and in men versus women. Marijuana is not recommended for use in people with a history of Heart Attack.
A 2 fold increased risk of Testicular Cancer has been shown in Marijuana users.
Legal Issues Associated with Medicinal Marijuana and THC
The Legality and Consequences of Marijuana, Delta-9-TetraHydroCannabinol (THC), and other Cannabinoids varies worldwide by region. Please consult the laws where you live regarding all Legal Issues and as always, do not make any changes to your medications (including pharmaceuticals, vitamin, supplement, or other) without doctor supervision and guidance.
Clinical Trials - Medical Marijuana
PET Test/Retest Brain Imaging of Cannabinoid CB1 Receptors Using [11C]MePPEP.
Measures CB1 Receptors in the brain to better understand how they work. Recruiting healthy patients.
The Effects of ∆-9-THC and Naloxone in Humans
The purpose of this project is to examine the effects of mu-opiate antagonism on the rewarding and reinforcing effects of delta-9-tetrahydrocannabinol (THC), the main psychoactive ingredient of cannabis.
Effects of Delta-9-THC and Iomazenil in Healthy Humans
The study aims to examine the combined effects of delta-9-tetrahydrocannabinol (∆-9-THC or THC) and iomazenil on thinking, perception, mood, memory, attention, and electrical activity of the brain (EEG). THC is the active ingredient of marijuana, cannabis, "ganja", or "pot". Iomazenil is a drug that works opposite to drugs like valium. The purpose of this study is to determine whether the administration of iomazenil will alter the effects of THC.
The Effects of Cannabidiol and ∆-9-THC in Humans
Cannabis is the most commonly used illicit substance in the US and herbal cannabis consists of a number of cannabinoids including Δ-9 THC and CBD. This study will characterize the interactive effects of the two major components of cannabis i.e. Δ-9-THC and CBD.
A Phase 1 Study of Dexanabinol in Patients With Advanced Solid Tumours
This study is a trial of Dexanabinol in patients with advanced solid tumours. The purposes of this protocol are to study different doses of the study drug to determine the maximum safe dose and to further understand the safety of the study drug; to understand what the body does to the study drug; to understand what the study drug does to the body and to measure any reduction in size of patients' cancer tumour(s).
Dexanabinol is a synthetic nonpsychotropic cannabinoid derivative which was initially developed as a neuroprotective agent due to its antiinflammatory activity. Because of its method of action however it is thought that it may have the effect of destroying cancer cells by reducing the level of control on networks that prevent cancer cells dying.
Inflammatory Bowel Disease
Cannabis for Inflammatory Bowel Disease
Background: The marijuana plant Cannabis has been used for centuries in the medicinal treatment of many disorders and is still the subject of medical research and public debate. Cannabinoids have been purported to alleviate a variety of neurological conditions such as MS-related symptoms including spasticity, pain, tremor and bladder dysfunction. Other neurological conditions like chronic intractable pain, dystonic movement disorders and Tourette's Syndrome were all reported to be alleviated by cannabis use. Cannabis has been used to treat anorexia in AIDS and cancer patients. In gastroenterology cannabis has been used to treat symptoms and diseases including anorexia, emesis, abdominal pain, gastroenteritis, diarrhoea, intestinal inflammation and diabetic gastroparesis.
Cannabinoids have also a profound anti inflammatory effect, mainly through the CB2 receptor. Cell mediated immunity may be impaired in chronic marijuana users. And a potent anti-inflammatory effect of cannabis was observed in rats . Studying the functional roles of the endocannabinoid system in immune modulation reveals that there are no major immune events which do not involve the endocannabinoid system. Cannabinoids shift the balance of pro-inflammatory cytokines and anti-inflammatory cytokines towards the T-helper cell type 2 profiles (Th2 phenotype), and suppress cell-mediated immunity whereas humoral immunity may be enhanced. They are therefore used for various inflammatory conditions including rheumatoid arthritis and asthma. In a mouse model of colitis cannabinoids were found to ameliorate inflammation and there are many anecdotal reports about the effect of cannabis in inflammatory bowel disease. However, there are no methodical reports of the effect of cannabis on inflammatory bowel disease. The aim of the proposed study is to examine in a double blind placebo controlled fashion the effect of smoking cannabis on disease activity in patients with IBD.
Cannabidiol for Inflammatory Bowel Disease
There are many anecdotal reports about improvement of Inflammatory bowel diseases (IBD) with cannabis smoking. The most effective anti inflammatory compound known today is cannabidiol. cannabidiol can be extracted from the cannabis plant, it has no central effect and is fat soluble so it can be given as drops in oil. Doses of up to 500mg did not cause any side effects.
The aim of the proposed study is to examine in a double blind placebo controlled fashion the effect of cannabidiol on disease activity in patients with IBD.
Neurophysiological Study of Sativex in Multiple Sclerosis (MS) Spasticity (NS-MSS)
Aim of this randomized, double-blind, placebo-controlled, cross-over study is to investigate cannabinoid-induced changes in neurophysiological parameters in a group of 40 patients with secondary or primary progressive Multiple Sclerosis (MS).
Cannabis for Spasticity in Multiple Sclerosis
The purpose of this study is to learn if the use of inhaled cannabis (marijuana) and oral cannabinoid (dronabinol, Marinol or THC, which is an active ingredient of marijuana) is safe and effective in reducing the symptoms of spasticity and tremor in patients with secondary-progressive or primary progressive multiple sclerosis.
Cannabinoid Modulation of Pain
The purpose of this study is to test the effects of cannabinoids on pain response using a variety of human experimental pain models.
The Effects of Cannabinoid on Patients With Non-GERD Related Non Cardiac Chest Pain
Noncardiac chest pain (NCCP) includes central and peripheral hypersensitivity, and mechanophysical abnormalities. Treatment of NCCP has focused on relieving visceral hypersensitivity through pain modulators. Only 40-50 % respond and clearly there is a large unmet therapeutic need.
Cannabis is felt to be beneficial for vomiting, diarrhea and intestinal pain. The main component of Cannabis acts through specific receptors, that are located primarily on central and peripheral neurons (including the enteric nervous system) and myenteric plexus where they modulate neurotransmitter release. Activation of these receptors reduces excitatory enteric transmission and may improve esophageal hyperreactivity and hypersensitivity, the hallmarks of NCCP.
Efficacy Study of Δ9-THC to Treat Chronic Abdominal Pain (Delta-pain)
The main goal of this trial is to study the efficacy of Namisol® after a single dose of Δ9-THC in the treatment of pain resulting from chronic pancreatitis. Objective measures of pain processing, e.g. encephalography (EEG) and quantitative sensory testing (QST), are included to provide insight in underlying nociceptive processing.
In Vitro Studies on Pharmacological Regulation and Genetic Risk Factors of Peripheral Human Nociceptors
This protocol is for a number of in vitro studies using human surgical biopsies and evaluating the pharmacology and genetics of human nociceptors ("pain detecting") neurons
Δ9-THC (Namisol®) in Chronic Pancreatitis Patients Suffering From Persistent Abdominal Pain
Abdominal pain resulting from chronic pancreatitis (CP) is often recurrent, intense and long-lasting, and is extremely difficult to treat. Medical analgesic therapy is considered as first choice in pain management of CP, resulting in regularly prescription of opioids. The adverse consequences of prolonged opioid use, including addiction, tolerance and opioid induced hyperalgesia, call for an alternative medical treatment. Cannabis has been used to treat pain for many centuries. Delta-9-tetrahydrocannabinol (Δ9-THC), the psychoactive substance of the cannabis plant, has been shown in previous studies to be a promising analgesic. The development of Namisol®, a tablet containing purified Δ9-THC showing an improved pharmacokinetic profile, provides the opportunity to test the analgesic potential of Δ9-THC in favourable conditions. The current study aims to investigate the analgesic efficacy of Namisol® as add-on analgesic during a long-term treatment (52 days) of abdominal pain resulting from CP.
The Analgesic Efficacy of Δ9-THC (Namisol®) in Patients With Persistent Postsurgical Abdominal Pain
Persistent postsurgical abdominal pain (PPAP) is a very difficult to treat pain. This pain can persist for months or even years and significantly diminishes quality of life. The exact underlying cause for this pain persistence is still unclear, which makes its treatment still a challenge. The promising analgesic effects of Δ9-THC in previous research, plus the improved bioavailability of Namisol® in comparison with previous Δ9-THC substances form the basis of the present research proposal.
The current study aims to investigate the analgesic efficacy of Namisol® as add-on analgesic during a long-term treatment (52 days) of persistent postsurgical abdominal pain.
Stem Cell Transplant
Cannabidiol for Graft Versus Host Disease (GVHD) Prophylaxis in Allogeneic Stem Cell Transplantation
Graft versus host disease (GVHD) is one of the major causes of death in patients undergoing allogeneic hematopoietic cell transplantation. Despite prophylactic measures, the incidence of acute GVHD is estimated at 40-60% among patients receiving transplant from HLA-identical sibling donors, and may even reach 75% in patients receiving HLA-matched unrelated transplants. More effective prevention and treatment strategies are needed.
The immunomodulatory and anti-inflammatory properties of Cannabinoids have been shown in animal models of various inflammatory diseases including multiple sclerosis, inflammatory bowel disease and rheumatoid arthritis.
Cannabidiol is a major non-psychoactive cannabinoid, which has potent anti-inflammatory and immunosuppressive effects and may reduce the incidence and severity of GVHD after allogeneic stem cell transplantation.
Safety and Efficacy of Cannabidiol for Grade I/II Acute Graft Versus Host Disease (GVHD) After Allogeneic Stem Cell Transplantation
Graft versus host disease (GVHD) is one of the major causes of death in patients undergoing allogeneic hematopoietic stem cell transplantation. Despite prophylactic measures, the incidence of acute GVHD is estimated at 40-60% among patients receiving transplants from HLA-identical sibling donors, and may even reach 75% in patients receiving HLA-matched unrelated transplants. More effective prevention and treatment strategies are needed.
The immunomodulatory and anti-inflammatory properties of Cannabinoids have been shown in animal models of various inflammatory diseases including multiple sclerosis, inflammatory bowel disease and rheumatoid arthritis.
Cannabidiol is a major non-psychoactive cannabinoid, which has potent anti-inflammatory and immunosuppressive effects and may be effective for both prevention and treatment of acute GVHD after allogeneic stem cell transplantation.
Medical Marijuana Forums
After a lot of debate, the staff here at Crohnsforum.com has decided to allow public discussion of medical marijuana as a supplemental treatment option within this thread. If you would like to discuss medical marijuana in private due to the potential privacy and legal implications, we have a private forum HERE
. Please note that if you discuss medical marijuana in this thread, what you say will be found by the search engines. Before we get started, a few rules:
1. Please keep medical marijuana related discussion confined to this thread or the private forum.
2. Yes, medical marijuana is illegal in many jurisdictions. However, as research below indicates, medical marijuana has been shown to be an effective treatment option for some people with IBD. As such, it will be treated as a MEDICINE on this forum and we will give people choosing to explore its use the same respect as we would give someone choosing a medicine such as Prednisone or Remicade. If you oppose medical marijuana, that's fine and we respect that. But this thread is not a place for such debate.
3. There will be no offers to buy or sell medical marijuana in this thread, in the private forum, or via PM.
4. If you choose to explore the use of medical marijuana, we strongly suggest you discuss it with your medical team.
5. Feel free to post your personal experiences with medical marijuana whether positive or negative.
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