Abdominal pain and cramps
Often in the lower right abdomen, frequently colicky and worse after meals. In acute flare phases the pain can dominate everyday life.
Cureal treatment spectrum
Medical cannabis for Crohn's disease
Crohn's disease belongs in gastroenterological care. Medical cannabis does not replace flare treatment, maintenance of remission, biologics or necessary surgery. It can be considered as a complementary symptom therapy if abdominal pain, nausea, loss of appetite or sleep problems remain a burden despite standard therapy.
- Coordinate with gastroenterology
- Flare treatment stays
- Assess symptoms
Context
What is Crohn's disease?
Crohn's disease is a chronic inflammatory bowel disease (IBD). Unlike ulcerative colitis, Crohn's can affect any section of the digestive tract from the mouth to the anus, most commonly the junction between the small and large intestine (terminal ileum). The inflammation extends through all layers of the bowel wall and can lead to scarring, fistulas and strictures.
In Germany around 320,000 people live with a chronic inflammatory bowel disease, about half of them with Crohn's disease. The disease often first appears between the ages of 15 and 35, and men and women are affected about equally often.
The disease typically runs in flares with phases of relative calm (remission) in between. Complications include strictures, fistulas between sections of the bowel or to the skin, and malnutrition with iron deficiency, vitamin B12 deficiency and loss of bone density.
Symptoms
How Crohn's disease shows itself
Symptoms differ depending on the region affected and the phase of the disease. These points do not replace a diagnosis but help with an initial assessment.
Diarrhoea
Several bowel movements a day, often with mucus or blood, sometimes with marked urgency and changed bowel habits.
Nausea and loss of appetite
Persistent nausea, sometimes vomiting, often accompanied by weight loss and malnutrition.
Tiredness and exhaustion
Chronic inflammation, sleep disorders and deficiencies lead to marked daytime tiredness, which can also persist independently of an acute flare.
Weight loss and malnutrition
Unintended weight loss, iron deficiency, vitamin B12 deficiency and loss of bone density must be taken seriously and treated as well.
Red flags
Fever, signs of bowel obstruction, fistulas, heavy bleeding, dehydration or severe pain are not an indication for online cannabis treatment and call for urgent medical assessment.
Diagnostic work-up
Diagnosing Crohn's disease
The diagnosis is made by a gastroenterology practice or a hospital with a gastroenterology department, not by Cureal.
It is based on the 2024 S3 guideline on Crohn's disease from the DGVS, the medical history, physical examination, laboratory values (blood count, inflammatory markers such as CRP and faecal calprotectin) and endoscopic procedures such as ileocolonoscopy with biopsies, and if needed upper endoscopy and small bowel diagnostics via MR enterography.
Histologically, granulomas and transmural inflammation are looked for, which distinguish Crohn's from ulcerative colitis. For Crohn's disease, Cureal works exclusively on the basis of an existing gastroenterological diagnosis and in coordination with the treating practice.
How the diagnostic work-up works
- Medical history interview about symptoms, course of the disease and previous treatment
- Laboratory and stool diagnostics: blood count, CRP, faecal calprotectin
- Ileocolonoscopy with biopsies, MR enterography if needed
Conventional treatment
Therapy: treating Crohn's disease
Treatment follows the S3 guideline and has several layers. Medical cannabis complements these building blocks for persistent symptoms but does not replace them.
Flare treatment
Acute flares are usually treated with glucocorticoids such as budesonide or prednisolone to contain the inflammation quickly. Because of their side effects they are not suitable for long-term therapy.
Short-term useMaintaining remission
Anyone who is to remain stable after a flare needs maintenance therapy. Conventional options:
- 5-aminosalicylic acid (5-ASA, e.g. mesalazine) in milder cases
- Immunosuppressants such as azathioprine, 6-mercaptopurine or methotrexate
- Biologics (infliximab, adalimumab, vedolizumab, ustekinumab) or JAK inhibitors in moderate to severe cases
- Surgery for strictures, fistulas or other complications
Cannabinoid system
Why cannabis is only considered for symptoms in Crohn's
The body's own endocannabinoid system is particularly densely represented in the gastrointestinal tract. CB1 and CB2 receptors regulate bowel motility, pain perception, secretion and the inflammatory response, exactly the breadth of function regarded as the biological basis for using cannabis compounds for symptoms accompanying Crohn's.
THC-containing medications are associated with pain-relieving, appetite-stimulating and anti-nausea effects and are usually used at a low dose in the evening. In studies, CBD-rich medications show a clinical improvement in symptom burden without any improvement in endoscopic mucosal healing.
This does not replace reliable control of the bowel inflammation, fistula activity or strictures. Gastroenterological disease control remains decisive; at most, cannabis may be considered as a symptomatic complement.
Evidence
Crohn's disease and cannabis: the research
Compared with many other indications, the data is comparatively robust, above all for symptom relief.
Randomised controlled study (Clinical Gastroenterology and Hepatology): patients with treatment-resistant Crohn's disease received THC-containing cannabis cigarettes. The result was a clear reduction in the Crohn's Disease Activity Index compared with placebo, less abdominal pain, less nausea, better sleep and a better appetite.
A follow-up study by Naftali and colleagues (2017, Digestive Diseases and Sciences) found no relevant effect with low-dose CBD. A further study (2021, Journal of Crohn's and Colitis) showed a clinical improvement in the CDAI with CBD-rich oil, without mucosal healing. The Cochrane review by Kafil and colleagues (2018) and the work of Tartakover-Matalon and colleagues (2021, Pharmaceutics) discuss the mechanisms and call for further long-term studies.
Legal situation
Legal situation in Germany (as of 2026)
Medical cannabis has been available on prescription since 2017. There is no approved finished cannabinoid medicine for Crohn's disease; it is used exclusively outside its approved indication (off-label), based on an individual medical decision.
Cost coverage by German statutory health insurance is assessed case by case. With documented treatment resistance, intolerance of standard therapy or severely restricted quality of life, the chances are higher than with a purely symptomatic indication. Most patients pay for cannabis therapy privately.
Milestones
2017 Cannabis as medicine available on prescription
2024 Cannabis Act eases access
Process
How the route to a prescription works for Crohn's disease
The decision should fit in with gastroenterological treatment and is always made by the treating doctor in the individual appointment.
1
Medical history
The course of your Crohn's, current flare activity, previous therapy (biologics, 5-ASA, glucocorticoids, immunosuppressants, any operations) and the dominant everyday symptoms are discussed.
2
Medication check
The entire medication plan is checked for interactions, the symptom burden is assessed and everything is coordinated with gastroenterological treatment.
3
Indication
It is assessed whether cannabis therapy is medically justifiable for the individual situation.
4
Prescription
If the indication is suitable, a private prescription is issued, usually a THC-containing medication for the evening and a CBD-dominant medication for the daytime, with a precise explanation of how to take them.
5
Adjustment and monitoring
Treatment starts at a low dose following the principle "start low, go slow". After two to four weeks, effect, tolerability and how it fits with Crohn's treatment are reviewed.
Context
THC, CBD and choice of therapy
There is no standardised cannabis medication for Crohn's disease as a routine therapy. The active substance, dose and time of intake depend on the dominant symptoms, flare activity, complications and accompanying medication.
- THC-containing medications come first for marked abdominal pain, nausea and loss of appetite, usually in the evening and at a low dose.
- CBD-dominant medications may be considered during the day to reduce stress and pain, and combination products are often practical.
- Biologics, immunosuppressants, glucocorticoids and other medicines must be taken into account in the medication check.
Frequently asked questions
Questions about cannabis and Crohn's disease
These answers give you initial orientation. The specific assessment for your situation is made by the treating doctor.
What does cannabis do in Crohn's disease?
In many patients, medical cannabis can ease abdominal pain, reduce nausea, stabilise appetite and support calmer sleep during flare phases. A randomised controlled study by Naftali and colleagues (2013) showed a clear improvement in the Crohn's Disease Activity Index with THC-containing cannabis compared with placebo. A follow-up study from 2021 with CBD-rich cannabis oil confirmed the clinical effect but stressed that direct endoscopic mucosal healing is not to be expected. Cannabis can ease symptoms but does not replace biologics and 5-ASA.
Which cannabis may be considered for Crohn's disease?
The choice is made individually in the initial consultation and depends on the dominant symptoms. For marked abdominal pain, nausea and loss of appetite, THC-containing medications come first, started at a low dose and increased slowly. CBD-dominant medications may be considered during the day to reduce stress and pain. Combination products with a balanced THC/CBD ratio are in many cases the practical solution.
Can cannabis cure Crohn's disease or heal the mucosa?
No. According to current research, cannabis mainly eases symptoms (pain, nausea, appetite, sleep, quality of life). Direct endoscopic healing of the mucosa was not shown in the follow-up study by Naftali and colleagues (2021). Modifying the disease remains the job of established therapy with biologics, immunosuppressants and 5-ASA. Cannabis is a complementary symptom therapy, not a substitute for standard treatment.
Can I take cannabis together with biologics or immunosuppressants?
A combination is possible in many cases but requires careful medical supervision. CBD and THC can affect how certain medicines are broken down by the liver, which can change their effects and side effects. Any adjustment of existing medication is made exclusively in coordination with the gastroenterology practice. In the initial consultation the entire medication plan is recorded and possible interactions are discussed openly.
What side effects can cannabis therapy for Crohn's disease have?
Possible side effects are a dry mouth, tiredness the next day (above all if the evening dose of THC is too high), mild dizziness, a temporary increase in heart rate or a temporary increase in nausea during the adjustment phase. In patients with Crohn's, interactions with biologics and immunosuppressants must also be considered. That is why treatment starts low, is monitored regularly and is adjusted if needed.
Related topics
Further indications in the treatment spectrum
Crohn's disease often occurs together with other conditions. These topics are closely linked.
Ulcerative colitis
The second major chronic inflammatory bowel disease, with an overlapping range of symptoms and comparable areas of cannabis use.
Go to pageChronic pain
Persistent abdominal pain can become a burden in its own right even outside an acute flare. Cannabis therapy led by pain medicine can be considered here as a complement.
Go to pageSleep disorders
Sleep disorders caused by pain and stress are a typical accompanying symptom of Crohn's. Cannabis in the evening can stabilise sleep.
Go to pageHave accompanying Crohn's symptoms assessed by a doctor
If abdominal pain, nausea, loss of appetite or sleep problems are a burden despite gastroenterological treatment, a medical consultation can clarify whether medical cannabis is an option for your situation.