P020 Weeding out misinformation: An analysis of the online information available to patients on medical marijuana use in IBD
Authors: Jack Masur , Adam Greenfest , Lindsay Clarke , Nadeem Tabbara , Daniel Szvarca , Vivian Lee , Rahma Aldhaheri , Marie Borum 
Published: July 2019

BACKGROUND:
Inflammatory Bowel Disease (IBD), including Crohn's Disease and Ulcerative Colitis, are among several chronic conditions approved for treatment with medical marijuana. Although evidence based on observational and animal studies is minimal, it is suspected that modulation of endocannabinoid receptors may improve inflammation and therefore symptoms associated with IBD. Individuals increasingly use the internet to gain information about alternative therapies. However, there are no studies that have evaluated online resources addressing medical marijuana and IBD. The study evaluated the readability and quality of online information readily accessible to patients and assessed the therapeutic claims, precautionary warnings, and evidence to support the use of cannabis in IBD.

METHODS:
A Google search using the terms “Marijuana IBD” was performed. Exclusion criteria included all veterinarian websites, duplicates and those which were non-accessible. Websites were then categorized by intended audience, either professional or consumer. Readability was determined using the validated Flesch-Kincaid Grade Level Calculation. The validated DISCERN questionnaire was used to assess quality, with scores rated as Excellent 66–75, Very Good 56–65, Good 46–55, Average 36–45, or Poor ≤35. Websites were reviewed for therapeutic claims, inclusion of references, precautionary information about marijuana use and whether they discussed approved treatments for IBD. Statistical analysis using a 2-tailed Fisher's Exact Test and a Two Sample T-test were used with a P-value set at <0.05.

RESULTS:
100 websites were assessed with 89 websites meeting criteria for analysis. 75 (84%) were intended for consumers and 14 (16%) were for medical professionals. The average Flesch-Kincaid Grade level was 13.3, with no significant difference (P = 0.41) between consumer (13.2 grade level) and professional (14.0 grade level) websites. Quality was rated as “Average” (mean DISCERN score 42.6), with no significant difference (P = 0.08) based upon intended audience. Consumer websites offered significantly more (P = 0.04) claims of improvement in disease pathology and less frequently listed references (P = 0.002) than websites geared towards medical professionals. There was no significant difference between consumer and professional focused websites in the discussion of the approved therapy (P = 0.38). 19 of 89 (21.3%) websites included precautionary information regarding marijuana use in IBD with no significant difference in consumer sites compared to those for medical professionals (P = 0.17).

CONCLUSION(S):
This study demonstrated that a multitude of online resources exist with information on medical marijuana as alternative therapy for IBD patients. The majority of these websites were intended for consumers, however their readability grade level exceeds the National Institutes of Health 6th grade recommended reading level for medical information. While the quality of information was considered “Average” using a validated measure, there was variability in available evidence-based references and inconsistency in the inclusion of precautionary information as well as the therapeutic claims made by different websites. It is critical that readily available online information about cannabis therapy in IBD be readable, evidence-based and comprehensive in order to allow for informed medical decisions.