Issue 20

Clinical Question

Are patients with IBD more likely to use medical marijuana following legalization of the drug?

Editor’s Bottom Line

Experience from the United States suggests that legalization of marijuana will increase its recreational use among IBD patients, but not its use for medical purposes.

Reference

Merker AM, Riaz M, Friedman S, et al. Legalization of Medicinal Marijuana Has Minimal Impact on Use Patterns in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2018;24(11):2309–14. https://doi.org/10.1093/ibd/izy141

Synopsis

This study examined use of marijuana in IBD patients in Massachusetts five years after it was legalized for both medical and recreational purposes in that state in 2012. Researchers surveyed roughly 300 consecutive patients with IBD treated at a tertiary care centre in Boston in 2012, prior to legalization, and in 2017. They asked patients about their marijuana use, what benefits they felt it had and about their views on the drug.

While there was an increase in overall marijuana use in the IBD population after legalization, from 12.3% in 2012 to 22.8% in 2017 (P=0.001), use of the drug specifically for medicinal purposes did not increase significantly (10.2% in 2012 vs. 12.6% in 2017). Compared to those who reported never using marijuana, those who used it for medical purposes in 2017 were significantly more likely to have previously undergone surgery (61.7% vs. 32.3%; P<0.001), to have been hospitalized previously (44.7% vs. 28.3%; P=0.042), to have received biological therapy (72.3% vs. 53.5%; P=0.025) and to report chronic abdominal pain (66.0% vs. 31.5%; P<0.001).

Nearly 90% of patients taking the drug for chronic abdominal pain said marijuana either completely or moderately relieved this symptom, while a majority of those using the drug for nausea, poor appetite or diarrhea said marijuana helped alleviate those symptoms.

Over 39% of patients who had never used marijuana said they were interested in trying it for medicinal purposes, while 54% said legalization did not increase their likelihood of using marijuana medicinally.

Details

Study Design: Prospective cross-sectional survey
Funding: Brigham and Women’s Hospital
Allocation: Cohort
Setting: Single-center
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.