Expert Voices: Cannabis use in people with multiple sclerosis
In this installment of our “Expert Voices” series, Multiple Sclerosis News Today asked Thorsten Rudroff, PhD, to answer some of your questions about cannabis use with multiple sclerosis.
Rudroff is the director of the Integrative Neurophysiology Laboratory and an associate professor in the Department of Health and Human Physiology at the University of Iowa. He has a secondary appointment in the Department of Neurology in the Carver College of Medicine. He is a fellow of the American College of Sports Medicine and active member of the Society for Neuroscience, American Physiological Society, American Society of Neuroradiology, and International Cannabinoid Research Society.
Rudroff’s research interests include cannabis use in patients with multiple sclerosis and older adults, neurophysiology of fatigue in young and old adults, fatigue and fatiguability in multiple sclerosis, positron emission tomography-based imaging of glucose uptake and blood flow by skeletal muscle, spinal cord, and brain during fatiguing exercise.
He published more than 70 manuscripts in peer-reviewed journals and presented his research at national and internal conferences. His research on cannabis use in people with multiple sclerosis is currently funded by the National Institute of Health/National Institute of Neurological Disorders and Stroke.
What misconceptions surrounding cannabis use would you like to dispel?
There are some misconceptions I would like to point out.
First, it is often said that cannabis is not addictive or that it is psychologically addictive but not physically addictive. While it’s true that it is not very addictive, you can become addicted to it.
Second, it would be extremely difficult to die from an overdose. However, like any other drug, it is possible to use too much, either tetrahydrocannabinol (THC)- or cannabidiol (CBD)-heavy strains, which may lead to serious side effects.
Third, CBD will not produce the psychoactive effects of THC, but it may alter your mood, which is why CBD should be described as non-intoxicating, but not as non-psychoactive.
Fourth, pure CBD products still contain 0.3% THC, which can result in a positive drug test.
Any advice for those considering medical cannabis use?
Consult your neurologist as cannabis products may have interactions with other drugs that people with MS are taking. It is recommended to start with a CBD-dominant product. Use products from reliable and trustworthy dispensaries. Do not stop taking other prescribed drugs without consulting your physician.
Any words of caution?
In line with my previous answer, people with MS should be especially careful with THC. THC-heavy products can amplify already existing impairments, such as issues with cognitive function and postural balance, in people with MS.
Do you find that patients’ symptoms respond most positively to a THC-heavy or a CBD-heavy strain?
The best ratio of THC and CBD to treat symptoms for people with MS is currently unknown. My lab is currently conducting studies to assess the effects of different THC:CBD ratios on specific MS symptoms. Currently, the evidence suggests that CBD-heavy or 1:1 ratio cannabis products have most benefits without serious side effects.
What types of positive effects in medical cannabis use have you observed?
Medical cannabis may reduce pain and muscle spasticity. Additionally, in my research studies, many people with MS reported that they were able to reduce or even stop other analgesic drugs (opioids) by using medical cannabis.
There are several studies which showed positive effects of medical cannabis on muscle spasticity, fatigue, and neuropathic pain in people with MS.
Is there a recommended route of delivery for cannabis?
It is recommended to use capsules or oil, which can be easily dosed. Smoking is not recommended because of potential negative effects on the lungs.
Is there ongoing or recent research into cannabis that excites you?
Figuring out the most effective THC:CBD ratio for pain, fatigue, and muscle spasticity is challenging, but an exciting avenue of research. There is a lot of variability in MS symptomology. Therefore, different patients might need different cannabis products. Rather than MS patients experimenting with different products to find the best ratio for themselves, we are hoping to provide better guidelines for cannabis use in this population. So far, it seems that CBD and its neuroprotective potential will be beneficial for our MS patients.
Expert Voices is a monthly series involving a Q&A with an expert in the MS space about a specific topic. These topics and questions are curated from a survey in which we ask readers what they want to learn more about from experts.
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