Negative impact of cannabis use on clinical outcomes in inflammatory bowel disease (IBD)
Glickman D et al, Inflamm Bowel Dis. 2024;30(7):1055–61
In this large patient cohort, cannabis use was associated with several poor clinical outcomes including steroid and opioid use, emergency department visits and hospitalizations while IBD-related surgery and mortality was not affected.
Background: Cannabis use is common in inflammatory bowel disease (IBD). Recent studies demonstrated that use of cannabis may relieve symptoms; however, it is still unclear how safe cannabis and its derivatives are for IBD patients. The authors performed this study to evaluate the impact of cannabis use on several key clinical outcomes in IBD.
Methods: They performed a retrospective study using the TriNetX Diamond Network. Cannabis use and non-cannabis use subcohorts were identified for 3 patient groups: (1) IBD, (2) Crohn's disease (CD), and (3) ulcerative colitis (UC). Baseline differences between subcohorts for each group were controlled by propensity score matching. In each group, relative incidence of emergency department (ED) visits, hospitalization, corticosteroid use, opioid use, IBD-related surgery, and death between cannabis users and non-cannabis users was compared.
Results: IBD cannabis users demonstrated an increased risk for corticosteroid use (risk ratio [RR] =1.095; 95% confidence interval [CI]: 1.021–1.174; p = 0.011), ED visits (RR = 2.143; 95% CI: 2.034–2.257; p < 0.001), hospitalizations (RR = 1.925; 95% CI: 1.783–2.079; p < 0.001) and opioid use (RR = 1.35; 95% CI: 1.14–1.6); p < 0.001), but not an increased risk of IBD-related surgery or death. The CD and UC groups exhibited similar outcomes, except only CD demonstrated an increased risk for corticosteroid and opioid use.
Conclusion: Cannabis use in inflammatory bowel disease (IBD) patients is associated with several poor clinical outcomes, including increased risk of corticosteroid and opioid use, emergency department visits and hospitalization, though not IBD-related surgery or death. It is not clear what drives these risks or whether they are directly related to IBD-associated disease activity or other factors. Further prospective studies are warranted to more carefully investigate these relationships.