From the Journals

Adolescents, young adults endorse marijuana for IBD



Many adolescents and young adults with inflammatory bowel disease (IBD) use marijuana and perceive little to no harm from regular use, according to study findings.

In a cross-sectional study of 99 patients with IBD aged 13-22 years, 32% of participants reported ever having used marijuana or endorsing use in the past 6 months. Additionally, 42% of patients perceived little to no risk of harm with regular use, reported Edward J. Hoffenberg, MD, of the departments of pediatrics and psychiatry at the University of Colorado, Aurora, and his associates.

Young girl smoking marijuana Stockphoto4u/iStockphoto
Investigators used the Research Electronic Data Capture (REDCap) tool to collect self-reported data on appetite, pain, quality of life, depression, anxiety, and marijuana use in patients with IBD seen at Children’s Hospital Colorado between December 2015 and June 2017. Motivation for marijuana use was assessed via 35 yes/no questions. Serum tetrahydrocannabinol and cannabidiol levels were measured at enrollment, and patients also were asked about marijuana use in the past 6 months. Participants who had ever used marijuana and/or endorsed use in the past 6 months were considered “ever users,” wrote Dr. Hoffenberg and his colleagues in the study published in the Journal of Pediatrics.

Overall, 62 patients had a diagnosis of Crohn’s disease, 27 had ulcerative colitis, and 10 had indeterminate/unknown colitis. Patients in the ever-use group were older (mean, 17 years) than those in the never-use group (mean, 15.9 years). Serum cannabinoids were detected in 50% of patients in the ever-use group. “The detection of serum cannabinoids only in the ever-users is consistent with truthful reporting,” the researchers said.

Additionally, 80% of ever-users and 25% of never users perceived low to no risk of harm with regular use. After adjustment for age, ever-users were 10.7 times more likely to perceive low to no risk of harm (odds ratio, 10.7; P less than .001), the authors reported.

Weekly and daily marijuana use was reported by 52% and 31% of ever-users, respectively; 9% reported daily or almost daily use. Medical reasons for use was endorsed by 57%, and 53% reported physical pain relief as a reason. Nonmedical recreational or psychological reasons for use were reported by 87%. Problems with use were reported by 37% of users, including cravings or strong desire to use (20%), needing to use more to achieve the same effect (17%), and using a larger amount for longer than intended (17%).

“There is a need for further understanding of the potential medical benefits of marijuana use in IBD,” Dr. Hoffenberg and his associates wrote. “Theoretically, a different study design, such as a randomized controlled trial of marijuana use or placebo, could better evaluate the safety and benefit of frequent marijuana use for induction or maintenance of remission.”

Limitations of the study include difficulty determining differences in disease activity between groups because of the large number of patients with inactive or mild disease, as well as the need to group patients with Crohn’s disease and ulcerative colitis together because of the small total number of participants who endorse marijuana use.

The study was funded by the Colorado Department of Public Health and Environment. No conflicts of interest were reported.

SOURCE: Hoffenberg EJ et al. 2018. doi: 10.1016/j.jpeds.2018.03.041.

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