Marijuana-As-Medication

Jun 3, 2017 by

You can have me read this article to you instead of reading it yourself…

Or you can read it the old-fashioned way below…


tl;dr

There are a number of possible risks with marijuana, but they may not be what you think.  And because marijuana acts directly on the GI tract, it can be both helpful and harmful to some people with gastroparesis, IBS, and IBD.

Gastroparesis: Marijuana actually slows motility of the gut, from the stomach to the rectum.  This is reason to pause if you have gastroparesis – it may worsen symptoms instead of making them better.  On the other hand, it has the potential to make acid reflux better.

IBS: For those with IBS-C or IBS-M, be aware that marijuana slows the motility of the gut, which could make the symptoms of constipation much worse.  On the other hand, for those with IBS-D, the slowing of the motility has the potential to be helpful in reducing symptoms of diarrhea.

IBD: It appears that marijuana both slows down motility in the gut and also reduces inflammation – two things that could be helpful in IBD, particularly during a flare.  Thus, marijuana may be helpful for certain people after the other risks are considered.

Pain: Marijuana seems to be beneficial for certain types of pain, particularly for nerve pains associated with cancer and diabetes.  It is unclear how helpful it is for other types of pain, and there are many reasons that people with other health conditions should be cautious about using it.

This article runs a bit long, but it is packed full of helpful information!  I not only provide more information related to the short summaries above, I also cover many of the myths and risks related to marijuana use and how they may relate to you.

(As always, you are welcome to “read” this article through audio)

In the previous articles, we talked about all the different terms and names that are tossed around in relation to marijuana.  We even discussed the different ways that marijuana can be obtained – legally and medically.

It makes sense that the next topic for discussion should be whether or not marijuana is safe, and also whether or not it works for different uses.

So that’s what we’re going to talk about here, with a heavy emphasis on using marijuana to treat the symptoms of GI conditions.

General Risks with Marijuana

I can’t ever talk about any treatment or drug without making sure that I cover the concerns and risks that we should all be aware of.

The good news: Many of the ‘dangers’ that we commonly hear about with marijuana are related to its recreational use.  When used for specific medication indications, the most common side effects have actually been as simple as dizziness, drowsiness, and dry mouth.

The less good news: There are some larger general concerns that can come with the use of marijuana, and I want to make sure to address them here:

  • Psychosis:  This is not something that will be an issue for everyone, or even most people. However, there is good reason to believe that the use of marijuana can cause psychotic episodes in those with existing psychiatric disorders, such as schizophrenia.  It can also act as a ‘final straw’ for people that may be vulnerable to a psychiatric disorder but have not yet developed one.
  • Development:  The use of marijuana by a pregnant mother may cause problems for a baby that is developing in the womb. It also appears that children and teenagers that use marijuana at a young age may experience reduced development of the brain.  Thus, it is important to weigh the benefits against this risk if you are considering this medication for a child or for yourself while pregnant.
  • Addiction & Dependence:  Believe it or not, marijuana is not nearly as addictive as many of the other substances that we hear endless warnings about. For instance, nicotine (in cigarettes and otherwise) can cause addiction in as many as 68% of those that use it.  Marijuana, on the other hand, appears to have an addiction rate as low as 9%.  It is important to note, however, that if a person begins using marijuana as a teenager, this could double the risk for addiction.  So…the warnings aren’t totally bogus, they just may be a little extreme.
  • Mental Slowing:  Consistent use of marijuana over time, even in controlled, low doses for medical indications, may eventually lead to more permanent changes in motivation, intelligence, and cognition (processing of information). The ways that this can impact each person will be different, and it is unclear how much use is required in order to lead to these long-term changes.  But it’s definitely something to know before diving in!
  • Driving “under the influence”:   There is good evidence to show that driving while using marijuana increases the risk of having a car accident compared to people that do not use marijuana, so this should be taken into consideration for anyone that is using marijuana to treat their symptoms.
  • Hyperemesis syndrome:  This is an odd side effect that happens in a small number of people.  As you might expect from the name, it causes nausea, vomiting, and abdominal pain.  I don’t think I need to say anything more to those with GI conditions.  The message is clear – if this happens, you probably don’t want to use it again since it will only make your symptoms worse!  The good news is that it seems to go away when use is stopped and (strangely enough) with a hot shower.

 

Now you are more informed on the general risks with marijuana, as opposed to the hearsay that I see all over the internet.  For some people, the information above will be enough to say “OK, not for me!”.  For others, it’s good information to know as you read further.

Marijuana and the GI Tract

So let’s start off with something that I had no idea about until I started researching this article – marijuana acts directly on the GI tract.  In all kinds of ways.  There are actually receptors located throughout the stomach and intestines that react to the substances found in marijuana.  So the impact that marijuana can have on the GI tract is not just psychological.  That’s an important difference!

Here are the cliff notes:

  • There are two types of receptors in the body that respond to marijuana
    • One is found all over the nerves in the GI tract (more info on that here)
    • The other shows up only when the gut is inflamed, meaning that this receptor suddenly shows up a lot in conditions like IBD
  • These receptors can impact all kinds of functions in the GI tract, including…
    • Motility
    • Acid secretion
    • Gut sensations
    • Saliva production

Knowing that marijuana acts directly on the GI tract is only half of the story – we have to understand how it acts.  And this is where the truly important points come in for those with GI conditions.

What Marijuana Can Do To Your Gut

An awful lot, it turns out.  And it’s not all good news.  So let’s dig into it.

  • Marijuana slows GI motility. It reduces peristalsis from the stomach to the colon, delaying stomach emptying and intestinal transit.
    1. With long-term use, the slowed motility in the intestine may go away over time.
    2. The delay in stomach emptying continues to occur whether used for a long time or a short time.
  • Marijuana may reduce acid reflux. Using this drug will tighten up the esophageal sphincter, which in turn may make it more difficult for acid to shoot back up into the esophagus.
  • Marijuana only impacts nausea at certain doses.
    1. In order to obtain the anti-nausea effect with pure marijuana, you must also get the psychiatric and euphoric effects of the medication
    2. To avoid the psychiatric impact, it may be helpful to use pure CBD, or cannabidiol (more on the different parts of marijuana here). It does not cause the psychiatric effects but does seem to prevent nausea
    3. At higher doses, marijuana can actually make nausea worse. Too little doesn’t help, too much makes it worse – there is a sweet spot right in the middle that we are still trying to nail down.
  • Marijuana can reduce gut inflammation and slow over-active motility.
    1. This means that there may be great benefit for those with IBD – when the gut is inflamed, there are a lot of receptors waiting to suck up the chemicals in marijuana, which then slow down the gut and reduce the inflammation.
    2. This could also be particularly helpful to those with IBS-D

 

If you feel like you need to know more about the way that the GI tract works and is structured in order to really wrap your head around this topic, check out these articles (they even have a special diagram, made just for those of us with GI conditions!).

A Side Note: Marijuana and Pain

I know that this is a website about GI conditions, but we are not strangers to experiencing chronic pain.  And some of the pain that those of us with GI conditions experience is particularly difficult for doctors to pin down and treat.

The most common treatment options for pain – narcotics/opioids – are not real options for us because of the negative impact that these medications can have on the GI tract.  They slow motility, which slows the transit of food and other substances through the intestine, possibly worsening symptoms in a number of conditions.  They can also make acid reflux worse – again, not the greatest option!

The desire to consider an option such as marijuana is understandably appealing, and, as I’ve already said, becoming evermore available. Doctors and scientists are also studying the benefits of marijuana pretty heavily right now.  Unfortunately, the studies are still inconclusive, and it is not clear which products might have the most benefit for which types of pain.

The American Pain Society recently released an entire guideline for doctors regarding the possible use of marijuana and its extracts to treat pain.  This guideline recommends caution with use and also mentions that a high CBD component seems to work better for pain than the THC component.  This is a promising concept, as the CBD component also does not cause euphoria, and seems to carry fewer side effects that can make the use of marijuana difficult in everyday life.

In Summary…

As you might have expected, further research is needed before marijuana or CBD can be generally recommended to for any of the reasons discussed above.  However, that research is actively underway, and I will review articles and studies as they become available, right here on this website.

There are clear reasons that marijuana may not be the best option for everyone.  For those with gastroparesis or severe constipation, it seems clear that marijuana could make things worse.  On the other hand, if you have exhausted all of your other medication, lifestyle, and diet options, it may be worth it to test it out and see what happens.

However, there are people that will be particularly sensitive to some of the general risks with marijuana, and those should not be ignored.  Either way, no matter what your situation, a discussion about marijuana (with a doctor that you trust) is not at all a bad idea.  And in fact, if you are going to use marijuana recreationally or medically, your doctor and pharmacist should always be informed.  I have mentioned this before but I will say it again – marijuana can interact with other medications and supplements quite a bit, so your healthcare providers should always be aware that it is one of your treatment choices.

That sums up our discussion of marijuana (for now).  You can refer back to the previous two articles on this topic here and here.

And you can read more about natural remedies in general here.  Or you can take a break, but don’t forget to sign up for my newsletter (top right) on your way out in order to get updates directly to your inbox!

 

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