From the Guidelines
Medical marijuana may be considered for managing symptoms of Irritable Bowel Syndrome (IBS), but its use should be approached with caution and as part of a comprehensive management plan. For IBS patients considering cannabis, starting with low-THC, higher-CBD products is recommended, such as tinctures containing 5-10mg CBD with 1-2mg THC taken once or twice daily 1. Patients should begin with minimal doses (1-2.5mg THC) and gradually increase if needed, while monitoring for symptom relief and side effects.
Key Considerations
- Cannabis appears to work through the endocannabinoid system, which helps regulate gut motility, sensation, and inflammation 1.
- THC may reduce intestinal hypersensitivity and slow gut transit (helpful for diarrhea-predominant IBS), while CBD has anti-inflammatory properties 1.
- Common side effects include dry mouth, dizziness, and cognitive changes 1.
- Patients should consult healthcare providers before starting, especially if taking other medications, and be aware that medical marijuana remains illegal in some regions.
- Regular reassessment of benefits versus side effects is important, and cannabis should be used as part of a comprehensive IBS management plan that includes dietary modifications, stress management, and other treatments.
Current Guidelines and Recommendations
- The British Society of Gastroenterology guidelines on the management of IBS suggest that treatment should commence with dietary therapies or first-line drugs, and that cannabis is not a recommended first-line treatment 1.
- However, some studies suggest that cannabis may be beneficial for patients with severe or refractory IBS symptoms, and that it may be considered as part of a comprehensive management plan 1.
From the Research
Medical Marijuana and IBS
- There is limited research on the use of medical marijuana for Irritable Bowel Syndrome (IBS) specifically, but some studies suggest that cannabis may be used to alleviate IBS-related psychiatric symptoms 2.
- A 2020 study found that patients with cannabis use disorder have 40.7% higher odds for IBS hospitalizations, with a rising trend of cannabis use disorder and related psychiatric comorbidities 2.
- Another study from 2020 found that peppermint oil and tricyclic antidepressants were ranked first and second for efficacy in improving global IBS symptoms, but the study did not investigate the use of medical marijuana 3.
- A 2011 systematic review found that antispasmodics and antidepressants are effective for the treatment of IBS, but did not include medical marijuana as a treatment option 4.
- A 2022 review article discussed the potential role of cannabis as a supportive medication for inflammatory bowel disease, particularly in pain reduction, but noted that its impact on the underlying inflammatory process is unknown 5.
Treatment Options for IBS
- Antispasmodics, such as cimetropium/dicyclomine, peppermint oil, pinaverium, and trimebutine, have been shown to be effective in improving abdominal pain, global assessment, and symptom score in IBS patients 4.
- Antidepressants, including selective serotonin releasing inhibitors (SSRIs) and tricyclic antidepressants (TCAs), have also been found to be effective in improving IBS symptoms 4.
- Bulking agents, such as soluble fiber, have not been shown to be effective in improving IBS symptoms 4.