Crohn’s Disease is a chronic inflammatory disease of the small and large intestine affecting more than 1 million U.S. citizens. According to the CDC, “The majority of Crohn’s patients will require surgery at some point during their lives.” Join us in this discussion of how medical cannabis can help manage Crohn’s symptoms and progression.

1. Delivery Methods and Dosing:
Making the most of your medicine
Medical Cannabis and
Inflammatory Bowel
Disease
Special Guest, Patient and WCM Member David R.
Host: Becky DeKeuster, M.Ed, Director of Education
Producer: Ben Gelassen, Marketing Associate
An introduction for patients, families,
and caregivers

2. Does my GI disorder qualify me for #mmj?
§2422, 2.E.: “Post-traumatic stress disorder, inflammatory
bowel disease, dyskinetic and spastic movement disorders…”
§2422, 2.B.: “A chronic or debilitating disease or
medical condition or its treatment that produces
intractable pain, which is pain that has not
responded to ordinary medical or surgical measures
for more than 6 months…”
Source: Maine Revised Statutes Title 22, Chapter 558-C: Maine Medical Use of Marijuana
Act, http://www.mainelegislature.org/legis/statutes/22/title22sec2422.html

3. GI Disorders – An Overview
(Inflammation and ulceration
of inner lining of GI tract)
Ulcerative
Colitis (UC)
Crohn’s
Disease
Collagenous
and
Lymphocytic
Colitis
Irritable Bowel
Syndrome
All IBDs involve damage to the actual bowel tissues
While it can be painful and
debilitating, IBS does not
involve damage to the bowel
tissue itself
• Affects only colon
• Continuous pattern
• Pain, bleeding,
changes in stool
• Affects entire GI tract
• Discontinuous pattern
• Pain, nausea,
vomiting, loose stool,
weight loss
Inflammatory Bowel Disease
• Quite rare
• Also called
microscopic
colitis

4. Ulcerative Colitis & Crohn’s
Image source: National Library of Medicine, https://ghr.nlm.nih.gov/condition/crohn-disease

5. Common Treatments
Source: Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/crohns-disease/basics/treatment/con-20032061
•Sulfasalzine, mesalamine, corticosteroids
•Sulfas now considered of limited benefit; steroid side effects problematic
Anti-inflammatory
drugs
•Imuran, Purinethol, Remicade, Humira, Cimzia, Rheumatrex, Stelara
•Many were originally approved for use w/rheumatoid arthritis, psoriasis
Immune system
suppressors
•Cipro, Flagyl
•No strong evidence of effectivenessAntibiotics
•Anti-diarrheals, pain relievers
•Iron, calcium, Vitamin B-12 and D supplements
•Nutrition therapy to allow bowel to rest
Other

6. Why Might Cannabis Help?
Image source: David Guzman, “The Endocannabinoid System”
CB1 receptors help regulate intestinal
movement and secretions
CB2 receptors help regulate immune
response and inflammation by limiting
the amount of white blood cells sent to
a perceived threat

7. Why Might Cannabis Help?
Your ECSInflammation
Visceral Pain
Secretions
Digestive Motility
THC CBD
CB-1 CB-2

8. Promising Cannabis Research
“The effects of (THC) and cannabidiol alone and in
combination on damage, imflammation and in vitro motility
disturbances in rat colitis.”
Jamontt et al, British Journal of Pharmacology
June 2010
• Rat modeling with sulphasalazine as control group
• THC and CBD proved beneficial in a dose-response
relationship
• Alone or together
• Optimal dose 10mg
“In this model of colitis, THC and CBD not only reduced inflammation but also lowered
the occurrence of functional disturbances. Moreover the combination of CBD and THC
could be beneficial therapeutically, via additive or potentiating effects.”

9. Promising Cannabis Research
“Cannabis induces a clinical response in patients with Crohn’s
disease: a prospective placebo-controlled study.”
Naftali et al, Clinical Gastroenterology and Hepatology
October 2013
• 21 human patients, unresponsive to traditional therapies
• Placebo-controlled
• 5 of 11 subjects in the cannabis group had complete
remission
• 3 were weaned from steroid dependency
“…a short course (8 weeks) of THC-rich cannabis produced significant clinical, steroid-free
benefits to 10 of 11 patients with active Crohn's disease, compared with placebo,
without side effects.”

10. But Remember….
Brain cells with Alzheimer’s being grown in a
Petri dish (www.discovermagazine.com)
Female cannabis flowers are covered with small
crystals which contain dozens of active
therapeutic compounds

11. Cannabis Side Effects
Cannabis
has no
known
LD50
No known
negative
drug
interactions
Euphoria
Motor coordination problems
Short term memory loss
Red eyes
Dry mouth
Low blood pressure
Heart palpitations
Anxiety/panic/paranoia
Hallucinations
Remember, while unpleasant, too much cannabis alone is not fatal.
Time, water, food, and a relaxing environment all help.
Remember:
Start low,
Go slow

12. Methods of Administration
Inhalation Ingestion Topical
30 sec – 1 min.
Smoking/Vaping
Easy titration
Wide variety:
Tincture, foods,
beverages
5 to 10 min20 to 120 min.
Can be helpful for
neuropathic pain,
psoriasis
Can be difficult to
titrate
No psychoactivity
Flower &
concentrated oils

13. What is the process?
1. Talk to your primary or specialist doctor
Any MD, DO or NP can certify
Some work for practices or groups that do
not allow them to certify. Their patients
must go to a cannabis specialist doctor.
Be prepared to educate

14. What is the process?
2. Choose a provider
• Grow at home
• Designate a dispensary
• Designate an individual to be
a cannabis “caregiver”
A quality provider should:
• Offer many options (product & potency)
• Be able to coach and explain products clearly
• Lab test all products
• Give receipts, track inventory, charge sales tax
• Use no pesticides
• Make you feel safe

15. Further Reading
Massa F, Monory K. “Endocannabinoids and the gastrointestinal tract.”
Journal of Endocrinological Investigation, 2006.
Di Marzo V, Piscitelli F. “Gut feelings about the endocannabinoid system.”
Neurogastroenterology and Motility, May 2011.
Volz MS, Siegmund B. “Efficacy, tolerability, and safety of cannabinoids in
gastroenterology: A systematic review.” Schmerz (Berlin, Germany), Feb 2016.

16. Resources
www.pubmed.com
www.ccfa.org/maine
Support groups, education,
care providers and more
www.safeaccessnow.org

17. Delivery Methods and Dosing:
Making the most of your medicine
Thank you for your
time and attention!
What are your remaining
questions & concerns?
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