Randomized controlled trial★ Featured study

Cannabis induces a clinical response in patients with Crohn's disease: a prospective placebo-controlled study.

Naftali T, Bar-Lev Schleider L, Dotan I, Lansky EP, Sklerovsky Benjaminov F, Konikoff FM · Clin Gastroenterol Hepatol · 2013

can-nabis read by the owner, IBD since 1999 · published 2026-06-03

The read

The first randomized trial of inhaled cannabis for Crohn's disease, and the paper that mirrors the actual patient experience I've been living with since I was diagnosed in 1999.

Naftali and a Tel Aviv team randomized 21 patients with active Crohn's disease unresponsive to standard treatment. Eleven smoked THC-rich cannabis cigarettes (115 mg THC each) twice a day for eight weeks. Ten smoked placebo cigarettes from which the cannabinoids had been extracted out, so neither group could tell what they were getting just from the look or the dose schedule.

The primary endpoint was clinical remission, defined as Crohn's Disease Activity Index below 150. Five of 11 cannabis patients hit remission. Only 1 of 10 placebo patients did. Ten of the 11 cannabis patients had a clinical response (significant CDAI reduction); 4 of the placebo patients did. Patients on cannabis reported better sleep and stronger appetite.

What the trial didn't show was any change in inflammation markers like CRP, any endoscopic improvement, or any healing of the underlying disease. The inflammation itself didn't budge. The misery did.

That distinction matters and it tracks with what I've actually lived through. Prednisone, 6-MP, then Remicade (I was an early user when it was still being figured out for pediatric Crohn's): those are the drugs that actually change the inflammation. Remicade has kept me functioning for the last two decades. Cannabis doesn't replace any of that. What cannabis does for me, and what the Naftali patients reported, is take the edge off flare pain and let me eat enough to keep weight on when my appetite collapses. Two real things, neither of them disease modification.

Limitations are real: 21 patients, eight weeks, inhaled smoked product that's hard to standardize. But it's one of the few placebo-controlled cannabis-for-IBD trials in existence, and the symptom signal it captured matches what most IBD patients who've tried cannabis already know in private.

What this paper found

45% of cannabis patients (5 of 11) reached clinical remission vs 10% (1 of 10) on placebo.
Clinical response (significant CDAI reduction) in 91% of cannabis patients vs 40% on placebo.
Patient-reported sleep and appetite improvements were consistent across the cannabis arm.
One of the only placebo-controlled inhaled-cannabis trials for inflammatory bowel disease to date. The Naftali team has run follow-ups; this remains the foundational paper.

Where it falls short

Tiny sample, 11 patients per arm. Not large enough to confirm the effect size.
Eight-week trial. Long-term disease control not addressed; for that, you still need a biologic like Remicade or Humira or one of the newer agents.
No change in inflammation markers (CRP) or endoscopic appearance. The underlying inflammation didn't improve, only the symptoms.
Three of 11 cannabis patients relapsed within two weeks of stopping. Symptom relief depended on continued use.
Inhaled smoked cannabis is hard to dose consistently. Results may not translate to edibles, tinctures, or other formats.

Original abstract

BACKGROUND & AIMS: The marijuana plant Cannabis sativa has been reported to produce beneficial effects for patients with inflammatory bowel diseases, but this has not been investigated in controlled trials. We performed a prospective trial to determine whether cannabis can induce remission in patients with Crohn's disease. METHODS: We studied 21 patients (mean age, 40 ± 14 y; 13 men) with Crohn's Disease Activity Index (CDAI) scores greater than 200 who did not respond to therapy with steroids, immunomodulators, or anti-tumor necrosis factor-α agents. Patients were assigned randomly to groups given cannabis, twice daily, in the form of cigarettes containing 115 mg of Δ9-tetrahydrocannabinol (THC) or placebo containing cannabis flowers from which the THC had been extracted. Disease activity and laboratory tests were assessed during 8 weeks of treatment and 2 weeks thereafter. RESULTS: Complete remission (CDAI score, <150) was achieved by 5 of 11 subjects in the cannabis group (45%) and 1 of 10 in the placebo group (10%; P = .43). A clinical response (decrease in CDAI score of >100) was observed in 10 of 11 subjects in the cannabis group (90%; from 330 ± 105 to 152 ± 109) and 4 of 10 in the placebo group (40%; from 373 ± 94 to 306 ± 143; P = .028). Three patients in the cannabis group were weaned from steroid dependency. Subjects receiving cannabis reported improved appetite and sleep, with no significant side effects. CONCLUSIONS: Although the primary end point of the study (induction of remission) was not achieved, a short course (8 weeks) of THC-rich cannabis produced significant clinical, steroid-free benefits to 10 of 11 patients with active Crohn's disease, compared with placebo, without side effects. Further studies, with larger patient groups and a nonsmoking mode of intake, are warranted. ClinicalTrials.gov, NCT01040910.

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Tagged conditions

IBD & Crohn's disease →