Download PDF
Z Gastroenterol 2021; 59(10): 1068-1077
DOI: 10.1055/a-1400-2768
Originalarbeit

Cannabis use of patients with inflammatory bowel disease in Germany: a cross-sectional survey

Cannabiskonsum von Patienten mit chronisch entzündlichen Darmerkrankungen in Deutschland: eine Querschnittserhebung
Tanja Neufeld
1   Department for Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
2   Chair for Integrative Medicine, University of Duisburg-Essen, Bamberg, Germany
,
Katrin Pfuhlmann
1   Department for Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
2   Chair for Integrative Medicine, University of Duisburg-Essen, Bamberg, Germany
,
Beate Stock-Schröer
3   University of Witten/Herdecke, Faculty of Health/Department of Human Medicine, Witten/Herdecke, Germany
,
Lana Kairey
1   Department for Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
,
Nina Bauer
1   Department for Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
2   Chair for Integrative Medicine, University of Duisburg-Essen, Bamberg, Germany
,
Winfried Häuser
4   Department for Internal Medicine, Klinikum Saarbruecken, Saarbruecken, Germany
,
Jost Langhorst
1   Department for Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
2   Chair for Integrative Medicine, University of Duisburg-Essen, Bamberg, Germany
› Author AffiliationsSupported by: The on-board funds of the chair for Integrative Medicine
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background and Aims Progressive legalization and increasing utilization of medical cannabis open up potential new applications, including for inflammatory bowel disease (IBD). This study aimed to collect current figures on the use of and experience with cannabis among IBD patients in Germany.

Methods A 71-item questionnaire was mailed to a randomly selected representative sample of 1000 IBD patients.

Results Questionnaires were returned by 417 patients (mean age 49.1 ± 17.0 years; 55.8 % women; 43.4 % ulcerative colitis and 54.7 % Crohn’s disease). Seventy-three respondents (17.5 %) stated past cannabis use for recreational purposes, while 12 users mentioned usage at the time the questionnaire was completed (2.9 %). Seventeen patients (4.1 %) indicated past use of cannabis, and 18 participants (4.3 %) reported current use of cannabis to treat IBD. Perceived benefits of cannabis use by its users included reduced abdominal pain, improved sleep quality, and relief of unease and worry. They reported lower quality of life and higher levels of anxiety or depression than non-users. Of notice, 52.9 % of cannabis users obtained their cannabis from the black market. A total of 76.5 % of former and 50 % of current users did not report their cannabis use to the physician.

Conclusion This survey reveals the largest data set on cannabis use among IBD patients in Germany, with the potential for further research. Cannabis is mainly procured from the black market, with unknown quality.

Zusammenfassung

Die fortschreitende Legalisierung und zunehmende Nutzung von medizinischem Cannabis eröffnet potenzielle neue Anwendungsgebiete, z. B. im Bereich der entzündlichen Darmerkrankungen (CED). Ziel dieser Studie war es, aktuelle Zahlen über den Gebrauch von und die Erfahrungen mit Cannabis bei IBD-Patienten in Deutschland zu erheben. Ein 71 Punkte umfassender Fragebogen wurde an eine zufällig ausgewählte repräsentative Stichprobe von 1000 CED-Patienten verschickt. Die Fragebögen wurden von 417 Patienten zurückgeschickt (Durchschnittsalter 49,1 ± 17,0 Jahre, 55,8 % Frauen, 43,4 % Colitis ulcerosa und 54,7 % Morbus Crohn). 73 Befragte (17,5 %) gaben an, in der Vergangenheit Cannabis zu Freizeitzwecken konsumiert zu haben, während 12 Nutzer den Konsum zum Zeitpunkt des ausfüllens des Fragebogens erwähnten (2,9 %). 17 Patienten (4,1 %) gaben einen früheren Cannabiskonsum an, und 18 Teilnehmer (4,3 %) berichteten über einen aktuellen Cannabiskonsum zur Behandlung von CED. Zu den von den Nutzern wahrgenommenen Vorteilen des Cannabiskonsums gehörten: eine Reduzierung der Bauchschmerzen, eine Verbesserung der Schlafqualität und eine Linderung von Unruhe und Ängsten. Sie berichteten über eine geringere Lebensqualität und ein höheres Maß an Ängsten oder Depressionen als Nicht-Konsumenten. Auffällig war, dass 52,9 % der Cannabiskonsumenten ihr Cannabis vom Schwarzmarkt bezogen. Insgesamt 76,5 % der ehemaligen und 50 % der aktuellen Konsumenten meldeten ihren Cannabiskonsum nicht dem behandelnden Arzt. Diese Umfrage zeigt die größte Erhebung in Deutschland zum Thema Cannabiskonsum bei CED-Patienten, mit Potenzial für weitere Forschung. Cannabis wird hauptsächlich auf dem Schwarzmarkt beschafft, mit unbekannter Qualität.

Key words

inflammatory bowel disease - cannabinoids - endocannabinoid system

Schlüsselwörter

chronisch entzündliche Darmerkrankung - Colitis ulcerosa - Morbus crohn

Supplement



Publication History

Received: 04 December 2020

Accepted: 24 February 2021

Article published online:
22 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ng S, Shi HY, Hamidi N. et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 2017; 390: 2769-2778
    CrossrefPubMedSearch in Google Scholar
  • 2 Hein R, Köster I, Bollschweiler E. et al. Prevalence of inflammatory bowel disease: estimates for 2010 and trends in Germany from a large insurance-based regional cohort. Scand J Gastroenterol 2014; 49: 1325-1335
    CrossrefPubMedSearch in Google Scholar
  • 3 Burisch J, Jess T, Martinato M. et al. The burden of inflammatory bowel disease in Europe. J Crohn’s colitis 2013; 7: 322-337
    CrossrefPubMedSearch in Google Scholar
  • 4 Han B, Najafi M, Cooper DT. et al. Evaluation of transperineal ultrasound imaging as a potential solution for target tracking during hypofractionated radiotherapy for prostate cancer. Radiat Oncol 2018; 13: 151
    CrossrefPubMedSearch in Google Scholar
  • 5 Langhorst J, Anthonisen IB, Steder-Neukamm U. et al. Amount of systemic steroid medication is a strong predictor for the use of complementary and alternative medicine in patients with inflammatory bowel disease: results from a German national survey. Inflammatory Bowel Dis 2005; 11: 287-295
    CrossrefPubMedSearch in Google Scholar
  • 6 Langhorst J, Anthonisen IB, Steder-Neukamm U. et al. Patterns of complementary and alternative medicine (CAM) use in patients with inflammatory bowel disease: perceived stress is a potential indicator for CAM use. Complement Ther Med 2007; 15: 30-37
    CrossrefPubMedSearch in Google Scholar
  • 7 Langhorst J, Wulfert H, Lauche R. et al. Systematic review of complementary and alternative medicine treatments in inflammatory bowel diseases. J Crohn’s Colitis 2015; 9: 86-106
    CrossrefPubMedSearch in Google Scholar
  • 8 Torres J, Ellul P, Langhorst J. et al. European Crohn’s and Colitis Organisation topical review on complementary medicine and psychotherapy in inflammatory bowel disease. J Crohn’s Colitis 2019; 13: 673-685e
    CrossrefPubMedSearch in Google Scholar
  • 9 Hasenoehrl C, Taschler U, Storr M. et al. The gastrointestinal tract – a central organ of cannabinoid signaling in health and disease. Neurogastroenterol Motil 2016; 28: 1765-1780
    CrossrefPubMedSearch in Google Scholar
  • 10 Kafil TS, Nguyen TM, MacDonald JK. et al. Cannabis for the treatment of ulcerative colitis. Cochrane Database of Syst Rev 2018; 11: CD012954
    PubMedSearch in Google Scholar
  • 11 Hasenoehrl C, Storr M, Schicho R. Cannabinoids for treating inflammatory bowel diseases: where are we and where do we go?. Expert Rev Gastroenterol Hepatol 2017; 11: 329-337
    CrossrefPubMedSearch in Google Scholar
  • 12 Klein T, Cabral G. Cannabinoid-induced immune suppression and modulation of antigen-presenting cells. J Neuroimmune Pharmacol 2006; 1: 50-64
    CrossrefPubMedSearch in Google Scholar
  • 13 Tibiriça E. The multiple functions of the endocannabinoid system: a focus on the regulation of food intake. Diabetol Metab Syndr 2010; 2: 5
    CrossrefPubMedSearch in Google Scholar
  • 14 Lahat A, Lang A, Ben-Horin S. Impact of cannabis treatment on the quality of life, weight and clinical disease activity in inflammatory bowel disease patients: a pilot prospective study. Digestion 2012; 85: 1-8
    CrossrefPubMedSearch in Google Scholar
  • 15 Singh UP, Singh NP, Singh B. et al. Cannabinoid receptor-2 (CB2) agonist ameliorates colitis in IL-10(−/) mice by attenuating the activation of T cells and promoting their apoptosis. Toxicol Applied Pharmacol 2012; 258: 256-267
    CrossrefPubMedSearch in Google Scholar
  • 16 Hoch E, Friemel C, Schneider M. et al. Wirksamkeit und Sicherheit von Cannabisarzneimitteln: Ergebnisse der CaPRis-Studie. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2019; 62: 825-829
    CrossrefPubMedSearch in Google Scholar
  • 17 Bundesvereinigung. Cannabis – Was Ärzte bei der Verordnung wissen müssen. 2020
    Search in Google Scholar
  • 18 Rose M, Fliege H, Hildebrandt M. et al. Validierung der deutschsprachigen Version des “Short Inflammatory Bowel Disease Questionnaire” (SIBDQ). Z Gastroenterol 2000; 38: 277-285
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Löwe B, Wahl I, Rose M. et al. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord 2010; 122: 86-95
    CrossrefPubMedSearch in Google Scholar
  • 20 Kroenke K, Spitzer RL, Williams JBW. et al. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics 2009; 50: 613-621
    PubMedSearch in Google Scholar
  • 21 Kerlin AM, Long M, Kappelman M. et al. profiles of patients who use marijuana for inflammatory bowel disease. Dig Dis Sci 2018; 63: 1600-1604
    CrossrefPubMedSearch in Google Scholar
  • 22 Lal S, Prasad N, Ryan M. et al. Cannabis use amongst patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol 2011; 23: 891-896
    CrossrefPubMedSearch in Google Scholar
  • 23 Storr M, Devlin S, Kaplan GG. et al. Cannabis use provides symptom relief in patients with inflammatory bowel disease but is associated with worse disease prognosis in patients with Crohnʼs disease. Inflamm Bowel Dis 2014; 20: 472-480
    CrossrefPubMedSearch in Google Scholar
  • 24 World Drug Report. 2018; Sales No. E.18.XI.9.
  • 25 McIntyre E, Foley H, Diezel H. et al. Development and preliminarily validation of the Complementary Medicine Disclosure Index. Patient Educ Couns 2020; 103: 1237-1244
    CrossrefPubMedSearch in Google Scholar
  • 26 Naftali T, Lev LB, Yablecovitch D. et al. Treatment of Crohn’s disease with cannabis: an observational study. Isr Med Assoc J 2011; 13: 455-458
    PubMedSearch in Google Scholar