Cannabis and multiple sclerosis
Fact-checked by Research into cannabis and multiple sclerosis (MS) is ongoing, but available evidence suggests that cannabis-based therapies may help ease certain symptoms of the disease, particularly muscle tightness and pain.
Cannabis is a plant that has been used for medicinal purposes for thousands of years. While the legal status of cannabis varies widely by region, there are various formulations of cannabis-based medicines that are sometimes used to help manage symptoms in MS, an autoimmune disease in which inflammation damages nerves in the brain and spinal cord.
Of note, cannabis-based products are not considered disease-modifying therapies. Instead, they may be used as part of a broader autoimmune disorder treatment plan focused on easing symptoms.
Potential benefits of cannabis in MS
Most studies evaluating cannabis-based therapies in MS were relatively small and yielded inconsistent results, but reviews of available data suggest potential benefits for certain MS symptoms:
- Spasticity: Cannabis is best supported as a treatment for MS spasticity, characterized by muscle stiffness and spasms. Clinical trials consistently show that cannabis-based products make spasticity feel less bothersome to patients in daily life. More recent studies also suggest some improvements in clinician-rated measures of spasticity.
- Pain: Evidence indicates cannabis may ease pain related to nerve damage and therefore provide MS neuropathic pain relief. The effects are generally modest, so cannabis is generally only considered for patients whose pain is difficult to control with standard therapies.
Some studies suggest that cannabis-based products may also have benefits for other MS symptoms, but data for these symptoms are less consistent, and more research is still needed.
- Bladder problems: Limited evidence suggests that cannabis products could help ease MS bladder problems, particularly overactive bladder.
- Sleep issues: A few studies suggest that cannabis products could ease MS fatigue and sleep issues, but the data are not robust.
Studies have not found any clear benefit of cannabis on MS-related tremors.
THC vs. CBD
The cannabis plant contains more than 100 biologically active compounds called cannabinoids. The two most studied are tetrahydrocannabinol (THC) and cannabidiol (CBD).
THC is the primary psychoactive component of cannabis, meaning it is mainly responsible for the high associated with recreational cannabis use, whereas CBD is not psychoactive and does not cause a high. Marijuana is a colloquial term for cannabis products that contain high amounts of THC.
CBD and THC can have a wide range of physiological effects, and studies on the use of cannabinoids in MS have looked at both compounds. Research suggests that both THC and CBD may have benefits for MS.
| THC | CBD | |
|---|---|---|
| Psychoactivity | Psychoactive
Has intoxicating effects May be stimulating or sedating |
Not psychoactive
Is non-intoxicating Generally has calming effects |
| Possible therapeutic effects |
|
|
Various components of the cannabis plant can interact with each other, so the effects of any given cannabis-based product are dependent on its specific composition, including which cannabinoids are present and in what concentration.
Cannabis products used for medicinal purposes may contain naturally occurring cannabinoids isolated from the plant or lab-made versions with similar biological activity.
Different strains
The cannabis plant is originally native to Central Asia, but over the millennia, humans have cultivated it worldwide. Selective breeding practices have produced more than 700 different strains of cannabis, each with unique biochemical features.
These strains are generally categorized based on their cannabinoid composition and the expected effects on the body.
- Cannabis sativa strains typically have a higher THC-to-CBD ratio and are associated with more stimulating effects.
- Cannabis indica strains often contain more CBD than sativa strains, and are linked to relaxation and sleepiness.
- Hybrid strains generally fall between indica and sativa in terms of cannabinoid profile and effect.
However, most modern cannabis strains are complex hybrids, and experts increasingly consider the indica vs. sativa distinction an oversimplification. Some now prefer to describe cannabis products based on their specific chemical composition, called a chemovar.
The benefits of indica vs. sativa in MS are not established, and there is no evidence that one strain is best for people with the disease. Patients should discuss with their doctors which cannabis product would work best for their individual circumstances.
Cannabis treatment options for MS
Cannabis products can be administered in several ways, and many of these formulations have been explored for people with MS.
- Inhaled: Smoked or vaped cannabis products have a fast onset and provide quick symptom relief. However, they can cause lung inflammation and damage, making them the least recommended option for medical purposes.
- Edibles: These forms of cannabis are eaten or swallowed in the form of gummies, candies, baked goods, or capsules, and are then processed in the digestive system. They can take a few hours to kick in, but have long-lasting effects. Studies have shown potential benefits of oral cannabis extract for MS muscle stiffness relief and pain.
- Oral sprays: These products are also taken orally, but are absorbed under the tongue and enter the bloodstream directly, allowing for a faster onset. An oral spray called nabiximols — which is approved for MS in some countries under the brand name Sativex — has been associated with reductions in spasticity, pain, sleep problems, and bladder issues for MS patients.
Various other formulations may also be available. These include liquid tinctures that can be absorbed under the tongue or swallowed, and topical formulations (e.g., creams and patches).
Risks of cannabis use in MS
The safety profile of cannabis depends on the product, dose, and method of administration. Cannabis side effects in MS are usually mild to moderate in severity and may include:
- dizziness or lightheadedness
- diarrhea, nausea, or vomiting
- dry mouth
- urinary tract infection
- fatigue or drowsiness
- headache
- disorientation
- impaired attention and judgment
Other potential risks of cannabis use in MS could include:
- cognitive and memory impairment, especially in those with existing cognitive issues
- increased risk of psychosis in at-risk individuals, such as those with a family history of schizophrenia
- increased risk of cardiovascular complications, particularly in people with underlying heart conditions
- interference with neurological development in children and adolescents
People who use cannabis regularly typically develop a tolerance to it, meaning that a larger amount is needed to induce the same effect. While it is considered practically impossible to overdose on these products, heavy cannabis users may develop a physical dependence and experience withdrawal symptoms when they discontinue it.
Cannabis products may also interact with other medications, increasing the risk of unwanted side effects or reducing medication efficacy. People with MS should always consult their doctor before using cannabis products.
Legal status
The legality of cannabis or medical marijuana for MS varies by country. In the U.S., cannabis remains illegal at the federal level, but many states have passed laws that allow the use of cannabis products for medicinal and recreational purposes within their borders.
Cannabis is legally available for MS patients in most states.
Marijuana laws for MS and other medical and recreational purposes are constantly evolving. Patients should consult with their healthcare provider to determine what is legally available to them in their area.Â
| States | Status of medical cannabis for MS |
|---|---|
| Alabama, Arkansas, Mississippi, North Dakota, South Dakota | Available for spasticity and muscle spasms in MS |
| Alaska, Arizona, California, Colorado, Delaware, District of Columbia, Minnesota, Missouri, Montana, Nevada, Oregon, Rhode Island | Available for spasticity and muscle spasms in MS; also legal for recreational use |
| Florida, Hawaii, Kentucky, Louisiana, Nebraska, New Hampshire, Pennsylvania, Utah | Available for MS |
| Connecticut, Illinois, Maine, Massachusetts, Michigan, New Jersey, New Mexico, New York, Ohio, Vermont, Washington | Available for MS; recreational use is also legal |
| West Virginia | Available for severe or persistent muscle spasms |
| Maryland | Available for severe or persistent muscle spasms; recreational use is also legal |
| Oklahoma | Available at the discretion of the prescribing clinician |
| Virginia | Available at the discretion of the prescribing clinician; also approved for recreational use |
| Georgia, Iowa, North Carolina, Texas | Low-THC products available for MS or MS-related spasticity |
| Idaho, Indiana, Kansas, South Carolina, Tennessee, Wisconsin, Wyoming | Not legalized or not available for MS |
Three cannabis-based therapies have been approved by the U.S. Food and Drug Administration (FDA), although none specifically for MS. These include:
- Epidiolex (cannabidiol), a CBD-based medication used to treat certain forms of epilepsy
- Cesamet (nabilone), a synthetic THC formulation used to treat chemotherapy-induced nausea and vomiting
- dronabinol (sold as Marinol and Syndros), another synthetic THC product used for the same indication as Cesamet and also to treat weight loss in people with HIV
Nabiximols, an oral spray containing a nearly equal mixture of THC and CBD, has been approved in at least 29 countries, including Canada, Australia, and most European nations, as an MS spasticity treatment. However, this medication is not approved in the U.S.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
