Medical Cannabis Has a Role to Play in MS Treatment
Medical cannabis is subject to laws relating to the growing, possession, transport, and use of marijuana. These vary from country to country and, in the United States, from state to state.
There are also differences between marijuana for general and recreational use and for the same product for medical use.
Of course, on Multiple Sclerosis News Today, we are only concerned with medical cannabis and its use by people with multiple sclerosis.
From the scientific point of view, the efficacy of marijuana or cannabis (the terms are interchangeable) in treating neurological problems, including multiple sclerosis, epilepsy, and movement problems, is not clear.
Studies of the efficacy of cannabis for treating multiple sclerosis have produced varying results. The combination of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) extracts give subjective relief of spasticity, though objective post-treatment assessments do not reveal significant changes.1
Evidence also suggests that oral cannabis extract is effective for reducing patient-centered measures of spasticity. A trial of cannabis is deemed to be a reasonable option if other treatments have not been effective.2 Its use for MS is approved in 10 countries.3 A 2012 review found no problems with tolerance, abuse or addiction.4
Medical Cannabis: A Complex Question
The National Multiple Sclerosis Society in the US takes the view that the question of whether marijuana — produced from the flowering top of the hemp plant, cannabis Sativa — should be used for symptom management in MS is a complex one.
It says that there is general agreement that better therapies are needed for distressing symptoms of MS — including pain, tremor and spasticity — that may not be sufficiently relieved by available treatments. Still, there are uncertainties about the benefits of marijuana relative to its side effects.
The society supports the rights of people with MS to work with their MS healthcare providers to access marijuana for medical purposes in accordance with legal regulations where such use has been approved. In addition, the Society supports advancing research to better understand the benefits and potential risks of marijuana and its derivatives as a treatment for MS.
Across the Atlantic, in the UK, the situation is different. The MS Society says that People have claimed cannabis helps with some MS symptoms such as muscle spasms and stiffness as well as pain.
Surveys show significant numbers of people with MS in the UK use cannabis to manage their symptoms. Because medically tested cannabis-based treatments aren’t widely available, some people with MS obtain cannabis from other sources.
The difficulty in that country is that cannabis is a class-B controlled drug. That means that possessing, producing, and supplying it are all illegal. “Supply” includes sharing the drug with someone or giving it, even for free, to friends or relatives. The law doesn’t allow you to use as a defense the fact you were using cannabis for medical reasons.
However, the laws in some other European countries, notably the Netherlands and Spain, where I live, are much more liberal. In fact, Barcelona has been dubbed “the new Amsterdam” by some people.
There has been some research into using cannabis-based medicines for MS.
The Multiple Sclerosis Trust says that CAMS study, which involved 660 participants around the UK, looked at the effect of cannabis on various symptoms of MS, primarily on spasticity. Results of this study were mixed, with no significant effect on spasticity as measured by the Ashworth scale. However, some improvement was shown on the time taken to complete a 10-meter walk and patient satisfaction scores were positive.
Mixed Results in Trials
A systematic review published in December 2009 found that five out of six double-blind, randomized, controlled trials reported a decrease in spasticity and improved mobility in people with MS taking a combination of the cannabis extracts Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). All of the studies reported some side effects which seemed to be related to the dosage. Generally, the treatment was well-tolerated.
The CUPID trial explored whether cannabis might have a role in protecting the brain from damage by multiple sclerosis, a concept called neuroprotection. The results from the study showed that there was no difference between participants who took the cannabis based medicine and those on placebo, with the treatment having no overall effect on the rate of progression.
However, the MUSEC trial, which was completed in 2012, involved 279 people taking a cannabis based pill or placebo. The trial showed higher proportions of people on the active treatment reporting reductions in muscle stiffness, spasms and pain, and improved sleep quality.
Sativex is a cannabis based mouth spray. It is licensed in the UK as an add-on treatment for moderate to severe MS spasticity in people who receive inadequate relief from the standard oral anti-spasticity medicines or have experienced unbearable side effects while taking these medicines. Although it is licensed throughout the UK, it is only available through the National Health Service in the constituent country of Wales.
Wherever it is legal to grow cannabis plants, suppliers of medical marijuana have appeared. I have even met a judge in Washington state, US, who is cultivating plants. These suppliers are openly advertising their wares online and through the social media.
I have talked to one such supplier, based in Ontario, Canada. He sent me details of his entire range of ‘pain-killer’ products including medical marijuana. It’s not cheap.
He told me: “We sell medical marijuana: One ounce for $230 (Canadian dollars), Quarter pound for $410, Half pound for $800, and One pound for $1,650.” The approximate metric equivalents are: 28gm, 113gm, 227gm and 454gm.
And those prices don’t include shipping.
Have I been tempted? No, not so far. But it all depends on how my symptoms develop in the future. Never say “never.”
1 Lakhan SE, Rowland M (2009). “Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review.” BMC Neurology (Review).
2 Borgelt, LM; Franson, KL; Nussbaum, AM; Wang, GS (February 2013). “The pharmacologic and clinical effects of medical cannabis.”.Pharmacotherapy.
3 Clark PA, Capuzzi K, Fick C (2011). “Medical marijuana: Medical necessity versus political agenda.” Medical Science Monitor.
4 Oreja-Guevara, C (2012). “Treatment of spasticity in multiple sclerosis: New perspectives regarding the use of cannabinoids”. Revista de neurologia (Review) (in Spanish).
Note: 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. The opinions expressed in this blog article are not those of Multiple Sclerosis News Today and are only intended to spark discussion about issues pertaining to Multiple Sclerosis.