IBS and Medical Cannabis: The State of Research and Clinical Practice

Irritable Bowel Syndrome, or IBS, is the most common gastro-intestinal diagnosis. It is also one of the most difficult to treat, often leaving patients and healthcare professionals struggling to find the right approach. The potential of medical cannabis for managing symptoms associated with IBS is becoming more evident, as research continues to refine understanding of the endocannabinoid system’s role in gastrointestinal function.

Sante Cannabis has assessed over 8,000 patients over the last six years and served as an important recruitment site for the Quebec Cannabis Registry. Patients and their healthcare teams seek our support for the consideration of medical cannabis treatment when conventional medications have failed to provide sufficient relief. In our clinical experience, the effectiveness of medical cannabis treatment for IBS varies significantly from one patient to another, a reality that speaks to the importance of developing personalized treatment plans under the supervision of experienced healthcare professionals.

For the moment, Santé Cannabis clinicians treat patients who have IBS in conjunction with other diagnoses when conventional treatments have failed, using individually tailored plans and product selections to address associated symptoms such stress, anxiety, sleep disturbances and pain.

UNDERSTANDING IBS

IBS is characterized by recurrent abdominal pain associated with changes in bowel habits, which are divided into three main subtypes: IBS with predominant diarrhea (IBS-D), IBS with predominant constipation (IBS-C) and IBS with mixed bowel habits. (IBS-M).

IBS is also a non-specific disorder, meaning that it likely encompasses different pathologies that range from undefined gut dysfunctions to mental health and stress related issues. While Santé Cannabis does not typically see patients who have a primary diagnosis of IBS, our physicians and nurses have developed treatment plans for patients who suffer from it as a comorbidity. IBS is a common comorbidity in fibromyalgia and several other chronic pain disorders, including chronic fatigue syndrome, temporomandibular joint disorder, chronic pelvic pain and non-ulcer dyspepsia.

THE SANTÉ CANNABIS APPROACH

Our clinicians favour a holistic approach that aims to reduce anxiety, stress and pain, while incorporating elements such as dietary changes, meditation and psychotherapy.The rationale that underpins the treatment of IBS with medical cannabis is based on the understanding of the Endocannabinoid System (ECS) as a modulator of gastrointestinal propulsion, secretion and inflammation, as well as on the presence of receptors associated with the ECS in the gastrointestinal system.

Patients treated for IBS at Santé Cannabis are primarily prescribed CBD-rich oils. If patients experience difficulties falling asleep after the ingestion of CBD-rich oil, they may be prescribed THC:CBD balanced oil for use at night. Oils with higher ratios of THC can also be introduced during flare-ups or periods of increased discomfort but always in combination with CBD.

Evidence suggests CBD inhibits gastro-intestinal inflammation and may have a possible effect in controlling visceral hypersensitivity and pain, although studies remain in preclinical stages. Results from the limited studies on the use of THC have produced mixed results.

THE IMPORTANCE OF CLOSE OBSERVATION AND FOLLOW-UP

Santé Cannabis’ clinical experience also highlights the importance of avoiding oils with MCT, as some patients with IBS have reported digestive troubles or increased diarrhea from their use. Making sure to choose the most natural oil available or switching to capsules can help reduce the quantity of ingested oil and mitigate associated side effects.

The effects of medical cannabis on IBS symptoms vary greatly. Patients in retrospective and prospective studies have reported symptomatic relief from medical cannabis for gastrointestinal problems, but the body of evidence supporting its efficacy in IBS is still limited. In certain cases, patients are able to achieve total control of their symptoms or even resolve them. Others, however, experience side effects or observe no effects at all. When IBS therapies have been ineffective, the guidance of experienced healthcare professionals is crucial to helping patients determine if medical cannabis treatment could be beneficial.

While it is important to keep in mind the need for more and better research amid the diverse outcomes observed, the use of medical cannabis under the Santé Cannabis approach does hold out hope for IBS patients when other therapies have brought no relief.

TTRAINING OPPORTUNITIES FOR HEALTHCARE PROFESSIONALS

Quebec physicians interested in finding out more about the use of medical cannabis to treat gastrointestinal problems or other health concerns can register to our Prescriber Training Program for access to free support services and educational material, including the clinical guidelines we’ve developed for treating specific conditions.