This survey-based study provides insight into the knowledge, perceptions, and beliefs of IBD patients seen in our hospital setting regarding the use of cannabis and CBD oil as alternative therapies. Notably, both IBD patients and controls showed strong support for medical uses of cannabis and CBD oil. The beliefs on the efficacy of cannabis and CBD oil are comparable to that of prescribed medications (e.g., corticosteroids and biologics/immunosuppressants), suggesting that cannabis may be perceived as equally effective. These results show that there exists a strong belief that these substances could be favorable to various IBD symptom relief, including abdominal pain, diarrhea, anxiety, and inflammation.

Of note, a substantial portion of the IBD patients enrolled in this study reported personal experiences using cannabis (54%) and CBD oil (41%) in various contexts of use, including medical use, symptom relief, pain management, and mental health support. A large proportion, 63%, of IBD participants reported that cannabis had a somewhat, very, or extremely beneficial effect in relieving their IBD symptoms, while 57% held this belief about CBD oil. These results are consistent with several studies, including Lal et al. (2011), who found that 33–50% of lifetime cannabis users with IBD specifically used it for symptom relief, reporting improvements in abdominal pain, diarrhea, and appetite [10, 17]. Similarly, Ravikoff Allegretti et al. (2013) noted that 32% of lifetime cannabis users among IBD patients in the U.S. used it for symptom management, particularly for pain and appetite, with many expressing interest in cannabis-based treatments [9, 10, 17]. These self-described benefits may also contribute to the generally favorable perception of cannabis and CBD oil within the IBD community.

Interestingly, we found that IBD patients were more likely to have used cannabis or CBD oil for short-term symptom relief (37% and 26%, respectively) compared to long-term symptom relief (23% and 18%, respectively). Such a pattern indicates that, among IBD patients, these substances are considered to be more effective in the management of acute symptoms rather than in the long-term management of the disease. However, the survey did not assess dosages or concentrations used, limiting our ability to explore dose–response relationships. Given that cannabinoid effects can vary with dosage and frequency, future research should include quantitative tracking and possibly cannabinoid blood level analysis to enhance the objectivity of findings. Our study also did not distinguish consistently between cannabis and CBD oil in all questions, potentially masking substance-specific effects. Future surveys should be designed to differentiate between these products to allow for more precise analysis of perceived benefits and usage patterns.

Mechanistically, cannabinoids are believed to reduce inflammation in IBD via modulation of the endocannabinoid system, particularly CB1 and CB2 receptors found in the gastrointestinal tract. Activation of these receptors may influence cytokine release, gut permeability, and motility. Recent studies have further shown that cannabidiol (CBD) can modulate intestinal barrier function, alter the gut microbiome, and impact cytokine expression, mechanisms that may underlie its potential therapeutic effects in gastrointestinal disorders, including IBD [18]. Additionally, different modes of administration, such as oral ingestion versus topical or rectal formulations, can result in variable absorption and efficacy. Our survey did not collect detailed information on administration route, which should be addressed in future work.

Notably, our study indicated that while IBD patients perceived such substances as helpful, they used them in addition to conventional treatments, which could be indicative that some patients consider cannabis and CBD oil as complementary, not alternative therapies. Nevertheless, more research is needed regarding the long-term implications of cannabis and CBD oil use in IBD. A recent 2024 longitudinal study involving cannabis-based medicinal products reported sustained improvements in health-related quality of life over 18 months among IBD patients, highlighting the potential of cannabinoids in chronic symptom management [19]. However, a 2025 meta-analysis found that while patients report improved quality of life, objective clinical markers such as endoscopic activity and inflammatory levels did not significantly improve, underscoring the need for further trials that integrate subjective outcomes with clinical endpoints [20]. Interestingly, a few participants reported recreational use of CBD oil, which may reflect a misunderstanding of its non-psychoactive properties, which suggests potential gaps in their self-reported knowledge.

It is noteworthy to consider that 20% of IBD patients who used cannabis or CBD oil reported weight gain and increased appetite. Although these effects may be beneficial in some patients struggling with weight loss or lack of appetite, they may also raise concerns regarding metabolic consequences within the context of an increased risk of obesity and metabolic disorders in IBD. Interestingly, 33.9% of IBD patients reported a decrease in opioid dosage when using cannabis or CBD oil suggesting their possible role in mitigating opioid dependence in these patients. However, a few patients also showed increased intestinal side effects or required higher doses of opioids with the use of cannabis/CBD oil. Stress and allergy relief were also self-reported and not corroborated by biochemical validation. In addition, a 2025 study on women with IBD found that CBD use significantly improved nausea, pain, and appetite, suggesting potential sex-specific therapeutic responses [21]. Future studies should stratify outcomes by gender to better elucidate differential responses to cannabinoid-based interventions.

This study has several limitations that should be considered when interpreting the findings. As a cross-sectional study relying on self-reported data and a non-validated questionnaire, the results are exploratory and hypothesis-generating rather than causal. The overlap between medical and recreational motivations also made it difficult to isolate cannabis use specifically for therapeutic purposes. The control group was primarily recruited from friends and family members of IBD patients, which may have introduced selection bias. These individuals are more likely to possess prior knowledge of IBD or be exposed to related discussions around cannabis use. Such familiarity could have influenced their responses, particularly on questions concerning access, beliefs, or comprehension terminology. Future studies should consider recruiting control participants from the general population to reduce this potential bias. Additionally, the control group was smaller than the IBD group, and the majority of participants were from Ohio, limiting statistical power and the generalizability of subgroup comparisons. The overall modest sample size, particularly the small number of participants with UC, further limited subgroup analyses. Another limitation is the lack of data on dosage and frequency of cannabinoid use, which precluded the analysis of dose–response relationships. All findings were based on self-reported perceptions without biochemical or clinical validation. Incorporating objective measures such as biomarker analysis or clinician evaluations would enhance clinical relevance of future research. Despite these limitations, the high level of endorsement of cannabis and CBD oil as a medical treatment (IBD: 86.79%, controls: 84.85%) combined with internal consistency across responses and the use of control questions, suggests that the observed perceptions are unlikely to be attributable solely to sampling bias.

In summary, this study has shown increasing interest and positive perceptions by IBD patients toward the use of cannabis and CBD oil as complementary or alternative therapies for symptom management. While our findings suggest a patient-reported association between cannabinoid use and symptom relief, they should be interpreted as exploratory and hypothesis-generating. Future randomized, controlled studies are needed to determine efficacy, safety, and long-term outcomes. Additionally, efforts should be made to address potential concerns and misconceptions surrounding the use of these substances, particularly in the context of adverse effects and long-term implications for disease management.