Cannabis Tied to Lower IBD Mortality, Hospital Costs
COPENHAGEN – Mortality rate, length of hospital stay, and cost of hospitalization all drop significantly in patients with inflammatory bowel disease (IBD) concurrently using cannabis, shows a study that supports wider availability of the substance for specified medical use.
Inpatient mortality dropped by more than 70% in those patients concurrently using cannabis for another indication, compared with those not taking the drug, while total cost of hospitalization dropped by more than $11,000.
The findings were presented as a poster by Neethi Dasu, DO, PGY 6 Gastroenterology Fellow, at Jefferson Health Hospital, N.J., at the annual congress of the European Crohn’s and Colitis Organization. Dr. Dasu worked with coinvestigator Brian Blair, DO, FACOI, Gastroenterology Program Director, IBD specialist, at the same hospital.
“This study reveals substantial benefits of cannabis in the management of patients with IBD,” Dr. Dasu said. “Not only do patients spend less time in hospital, but they also have a decrease in mortality and hospital cost, which can be significant for patients with IBD, a chronic condition, that often burdens them with high health care spend.”
The researcher also highlighted that with annual U.S. health care spending on IBD having increased significantly in recent years, getting patients well and out of the hospital in a timely manner is key and that “cannabis might help in this aim.”
Cannabis use is legalized in some U.S. states for medical treatment of several chronic, debilitating disorders, especially cancer. Currently, there is no direct Food and Drug Administration approval for use for IBD. “Utilizing it would be considered off-label and investigational,” Dr. Dasu pointed out.
Patients report cannabis, as a pain control treatment, is effective for acute flares and chronic IBD, said Dr. Dasu. “It is an excellent agent for pain control that is not a narcotic, as with opioids, which can cause dependence and addiction. These could ultimately harm patients in the long term,” she addedin an interview. “Opioids can also cause drowsiness and side effects, which harm a person’s quality of life.”
Patients with IBD using cannabis concurrently
Dr. Dasu and her coresearchers aimed to see if outcomes including mortality and pain could be modified with “a very accessible and cost-efficient agent that does not cause long term addiction or adverse events.”
She added that previous studies had evaluated the clinical response in patients with IBD and concomitant cannabis use, but that their study was novel because it looked at inpatient outcomes as well as overall hospital cost.
Dr. Dasu and colleagues analyzed data over the years 2015-2019, from the Nationwide Inpatient Sample (NIS), a large publicly available all-payer inpatient care database, which encompasses approximately 7 million inpatient hospitalizations annually in the United States.
All included patients had IBD, either ulcerative colitis or Crohn’s disease, were aged 18 years and over, and used cannabis for a concurrent indication.
Odds ratios were calculated for in-hospital mortality, average length of hospital stay, and hospital charges, after adjusting for age, gender, race, primary insurance payer status, hospital type and size (number of beds), hospital region, hospital teaching status, and other demographic characteristics.
Of the 1,198,839 patients with IBD, 29,445 used cannabis for a different indication. Participants had an average age of 38.7 years.
Highly significant drop in mortality and hospital costs
Inpatient mortality shows a significant decrease of 72% (odds ratio, 0.28; confidence interval, 0.19-0.41, P < .0001) in those who concurrently used cannabis, compared with those who did not. Hospital length of stay also dropped by –0.17 days (95% CI, –0.35 to –0.01; P < .041), and this translated into a significant drop in the total cost of hospitalization from $39,309.00 (IBD without cannabis use) to $28,254.30 (IBD with cannabis use), resulting in an $11,054.70 savings (95% CI, –$13,681.15 to –$8,427.24; P < .0001).
As a chronic inflammatory disease, IBD involves immune dysregulation leading to symptoms of nausea, vomiting, bleeding, and abdominal pain; however, the pathophysiologic mechanism is not fully understood. She added that studies in mice had shown that cannabis acts via cannabinoid 1 and 2 receptors, located in the nervous system, to decrease pain, nausea, and vomiting. “Mechanisms of cannabis’s analgesic effect also involves inhibition of the release of neurotransmitters involved in pain and inflammation.”
Asked how she felt about the future for cannabis treatment in IBD, Dr. Dasu remarked that it would most likely require decriminalizing marijuana use on a federal level, although individual states currently offer exemptions.
“Further research should be done to evaluate the medical benefits of cannabis use in patients with IBD, with studies warranted to investigate the factors that may be driving these differences, as well warranted to investigations into the effect of cannabis on remission rates, rates of hospitalization, potential complications, and quality of life,” concluded Dr. Dasu.
Commenting on the study, Mary-Jane Williams, MD, a gastroenterology fellow at East Carolina University Health Medical Center, Greenville, N.C., told this news organization that the study was “a pleasant breath of information on the topic of cannabis use in IBD,” adding that providers often face questions about cannabis use from patients.
“Modulation of the endocannabinoid system … plays a key role in the pathogenesis of IBD including pain control, limiting intestinal inflammation, and decreasing intestinal motility,” Dr. Williams said, adding that, “Its use in IBD has promising improvement in the therapeutic effect and overall quality of life.”
“This study highlights and supports substantial therapeutic effects of cannabis in the management of IBD patients, be it their pain control, improving nausea, appetite and sleep, remission rates, earlier time to recovery, shortened hospitalization and faster endoscopic improvement,” she pointed out, noting the need for further studies, but also that most organizations, including the Crohn’s and Colitis Foundation, support policies that facilitate the conduct of clinical research using objective parameters and the potential development of cannabinoid-based medications in the management of our patients with IBD.
Dr. Dasu, Dr. Blair, and Dr. Williams have declared no financial disclosures.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
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