Cannabis and Multiple Sclerosis

The painful condition of multiple sclerosis (MS) affects an individual's mobility and subjects him or her to severe chronic pain. Symptoms associated with MS are typically pain, spasticity, sleep disturbances, mood disorders, muscle cramps and spasms, and bladder symptoms. There aren't too many known ways of treating this ailment effectively. Typical treatment involves the use of dangerous prescription medication such as opioids, benzodiazepines and muscle relaxers.

 

However cannabis with its growing reputation as a painkiller and anti-inflammation agent, mood regulator, sleep medicine, and medicine for fatigue, is increasingly becoming popular as a treatment for multiple sclerosis. Multiple sclerosis is one of the medical conditions that is now eligible for medical cannabis across US states where medical use of cannabis has been legalized. 

Cannabis can be administered in a number of ways, including as oromucosal sprays, edibles, oils and ointments. Cannabis is universal medicine, suitable for all age groups and genders.

Yet the number of individuals with multiple sclerosis in these US states, where medical cannabis has been legalized, is just a small fraction of the number of persons worldwide suffering from this debilitating condition. In many places, dangerous opioids, benzodiazepines,and other synthetic pharmaceutical medications are the only options available. This is mostly in affluent countries. For the majority of the world's population living in poverty, even these medications are not available, or are not affordable. Even medical cannabis only offers a solution to the lucky few, who meet the preconditions as well as those who can afford the medicine.

 

As more and more physicians and patients become informed about cannabis's potential to treat multiple sclerosis, and as more studies, finding and patient evidence emerges, let us hope that cannabis prohibitions will be lifted worldwide to enable patients to grow and access the plant freely and to use it as an effective option to treat multiple sclerosis.

Related articles

The following list of articles taken from various media speak about the above subject. Words in italics are the thoughts of yours truly at the time of reading the article. 

 

 

'Thousands of patients are being refused access to cannabis treatment which “could greatly improve their quality of life”, an organisation fighting multiple sclerosis has said.The incurable condition – which affects the brain and nerves and causes a range of symptoms including muscle spasms, pain and tiredness – can be managed with the help of a cannabis-based spray.

But despite the treatment – Savitex – being approved for NHS use in England more than two years ago, many patients are still being denied access to it, the MS Society said.'

https://www.thelondoneconomic.com/news/cannabis-nhs-treatment-savitex-ms-multiple-sclerosis-286546/

'Results
This review identified 12 cost-utility analyses conducted across a variety of diseases including multiple sclerosis (MS) (N = 8), pediatric drug-resistant epilepsies (N = 2), and chronic pain (N = 2). The incremental cost-effectiveness ratio varied widely from cost saving to more than US $451?800 per quality-adjusted life-year depending on the setting, perspectives, types of medicinal cannabis, and indications. Nabiximols is a cost-effective intervention for MS spasticity in multiple European settings. Cannabidiol was found to be a cost-effective for Dravet syndrome in a Canadian setting whereas a cost-utility analysis conducted in a US setting deemed cannabidiol to be not cost-effective for Lennox-Gastaut syndrome. Overall study quality was good, with publications meeting 70% to 100% (median 83%) of the Consolidated Health Economic Evaluation Reporting Standards checklist criteria.

Conclusions
Medicinal cannabis-based products may be cost-effective treatment options for MS spasticity, Dravet syndrome, and neuropathic pain, although the literature is nascent. Well-designed clinical trials and health economic evaluations are needed to generate adequate clinical and cost-effectiveness evidence to assist in resource allocation.'

https://www.sciencedirect.com/science/article/abs/pii/S1098301521015229

'Conclusions

More than 60% of the patients with MS who started add-on treatment with cannabinoid oromucosal spray reported a clinically relevant symptomatic effect and continued treatment after 12?weeks.'

https://link.springer.com/article/10.1186/s12883-021-02246-0

'Highlights

- personal cannabis is commonly used among persons with Multiple Sclerosis
- patterns of use, dosing, frequency and mode of delivery are diverse among survey respondents
- cannabis was associated with improved bladder symptoms when used specifically for bladder symptoms
- cannabis was associated with improved bladder symptoms even when not being used specifically for bladder symptoms'

https://www.sciencedirect.com/science/article/abs/pii/S2211034821003722

'We found that the majority of individuals from all groups used cannabis to address pain and improve quality of sleep. While PwMS reported lower baseline levels across all five outcomes, we found that the reported effects of cannabis were largely comparable across the groups. We also found that cannabis benefitted persons with sleep and digestive issues regardless of condition, whereas persons who used opioids in addition to cannabis were less likely to experience an improvement in any of the outcomes. This comparative evaluation suggests that cannabis’ effects are not specific to MS, arthritis, or cancer as much as they impact processes common among these distinct conditions. We also found evidence that cannabis may be a viable alternative to opioids for those with these conditions and experiencing pain.'

https://www.mdpi.com/2076-3425/11/5/532

'A team of investigators affiliated with the Yale University-Griffin Prevention Research Center conducted structured surveys with 115 MS patients regarding their use of cannabis. Respondents were most likely to report that cannabis was effective in reducing symptoms of pain, insomnia, muscle cramps and spasms, as well as improving mood. Consistent with studies of other patient populations, “a significant proportion of respondents” reported having either “stopped or reduced” their use of prescription medications after finding cannabis to be more effective for symptom management. In particular, patients frequently reported reducing or ceasing their use of “opioids, benzodiazepines, muscle relaxers and other pain medications” – a finding that is also consistent with other studies.'

https://norml.org/news/2021/03/11/survey-cannabis-use-by-patients-with-multiple-sclerosis-associated-with-reductions-in-need-for-prescription-medicines

'Results
Self-reported benefit from cannabis use for two or more symptoms of MS was associated with relapsing remitting MS (RRMS) vs progressive (PMS) (OR 3.043, 95% CI 1.026-9.028, p=0.038) and less benefit for two or more symptoms for those who required a wheelchair vs. those who ambulated without assistance (OR .246, 95% CI .195-.797, p=0.016). General benefit from cannabis use was reported for mood disorders ( p<0.001), insomnia ( p<0.001), sensory symptoms, including pain ( p<0.001), and muscle cramps and spasms ( p<0.001). Furthermore, benefit was also significantly associated with symptom severity in the case of insomnia (OR 9.735, 95% CI 2.751-34.445, p<0.001), and cramps and spasms (OR 5.234, 95% CI 1.261-21.729, p=0.014). A significant proportion of respondents had stopped or reduced prescription medications (86% vs. 55%, p<0.001) as a function of finding cannabis more effective than prescription medications. These included opioids, benzodiazepines, muscle relaxers and other pain medications.

Conclusion
MCU among PWMS [persons with multiple sclerosis] can lead to the reduction or discontinuation of several categories of prescription medications for symptoms of MS. Persons reporting the most benefit from MCU tended to have a milder form of MS with less disability, in contrast to previous studies. This study confirms the benefit of cannabis in several common MS symptoms, extending these findings to show that benefit can be related to baseline severity of some symptoms.'

https://www.msard-journal.com/article/S2211-0348(21)00096-1/fulltext

'Fifteen cases (53.6%) reported that their symptoms were improved by cannabis. Proinflammatory cytokines were significantly elevated in the MS group compared to the MS/cannabis and control groups. Additionally, anti-inflammatory cytokines had significantly lower values in the MS group compared to the MS/cannabis and control groups. Most clinical symptoms were significantly improved in the MS/cannabis group compared to the MS group apart from sexual dysfunction, bladder symptoms, and visual disturbances. Mild side effects of cannabis were also reported. Conclusion. Cannabis may have a positive impact on the cytokine and clinical profiles in cases with multiple sclerosis.'

https://www.hindawi.com/journals/msi/2021/6611897/

'Treatment with medical cannabis oils was safe and well tolerated, and resulted in a reduction in pain intensity, spasticity and sleep disturbances in MS [multiple sclerosis] patients. This suggests that medical cannabis oils can be used safely, especially at relatively low doses and with slow titration, as an alternative to treat MS-related symptoms when conventional therapy is inadequate. '

https://www.msard-journal.com/article/S2211-0348(20)30782-3/fulltext


'Results
At T0, neurophysiological variables did not differ significantly between patients and controls. At T1, spasticity and pain scores improved, as detected by the Modified Ashworth Scale or MAS (p=0.001), 9-Hole Peg Test or 9HPT (p=0.018), numeric rating scale for spasticity or NRS (p=0.001), and visual analogue scale for pain or VAS (p=0.005). At the same time, the CSP was significantly prolonged (p=0.001).

Conclusions
The THC-CBD spray improved spasticity and pain in secondary progressive MS patients. The spray prolonged CSP duration, which appears a promising tool for assessing and monitoring the analgesic effects of THC-CBD in MS [multiple sclerosis].'
https://onlinelibrary.wiley.com/doi/abs/10.1111/ane.13313


'Results: Fifteen articles met inclusion criteria and were included in this review.

Conclusions: The literature review provided evidence in supporting the use of medical marijuana to reduce common symptoms reported in patients with MS. Stronger evidence for improvements in pain and spasticity were commonly seen in the reviewed literature. Adverse effects were reported in all studies, and further follow-up studies are necessary to identify long term effects of using medical marijuana in controlling the symptoms associated with MS.'
https://digitalcommons.misericordia.edu/research_posters2020/76/


'Results:
In total, we reviewed 14 real-world publications including observational studies and treatment registries. The proportion of patients reaching the threshold of minimal clinical important difference (MCID), with at least a 20% reduction of the spasticity Numeric Rating Scale (NRS) score after 4 weeks ranged from 41.9% to 82.9%. The reduction in the mean NRS spasticity score after 4 weeks was maintained over 6-12 months. The average daily dose was five to six sprays. Delta-9-tetrahydrocannabinol: cannabidiol was well tolerated in the evaluated studies in the same way as in the RCTs. No new or unexpected adverse events or safety signals were reported in everyday clinical practice.

Conclusions:
The data evaluated in this systematic review provide evidence for the efficacy and safety of THC:CBD in clinical practice and confirm results obtained in RCTs.'
https://journals.sagepub.com/doi/abs/10.1177/1179573519831997


'The first bulk batch of medical cannabis imported into the U.K. since it was legalized for prescription last year has arrived from the Netherlands.

The shipment, exported by the Office of Medical Cannabis, will be sent directly to pharmacies to provide to patients under prescription for treating conditions including chronic pain and multiple sclerosis, according to a statement from British startup Grow Biotech. The company said it worked with investor European Cannabis Holdings and pharmaceutical importer IPS Specials to facilitate the delivery.'
https://www.bloomberg.com/news/articles/2019-02-15/the-u-k-just-got-its-first-bulk-shipment-of-medical-cannabis


'In the Sativex® as add-on therapy versus further optimized first-line ANTispastics (SAVANT) study, add-on THC:CBD spray was significantly more effective than readjusting standard antispasticity therapy and provided new evidence of efficacy as requested by German authorities.'
https://www.futuremedicine.com/doi/abs/10.2217/nmt-2018-0050


'In this proof-of-concept trial, nabiximols (standardised oromucosal spray containing a defined combination of delta-9-tetrahydrocannabinol and cannabidiol (each 100 µL actuation contained 2·7 mg delta-9-tetrahydrocannabinol and 2·5 mg cannabidiol)) had a positive effect on spasticity symptoms in patients with motor neuron disease and had an acceptable safety and tolerability profile. These findings should be investigated further in larger clinical trials.'
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30406-X/fulltext


https://blogs.scientificamerican.com/observations/pot-shows-promise-for-reducing-multiple-sclerosis-patients-symptoms/


'The increasing usage of cannabinoids in a variety of medical conditions highlights the crucial need to better understand the physiological roles of cannabinoids in the periphery. Here we reveal evidence of their involvement in regulating neuromuscular transmission, and a possible therapeutic potential for cannabinoid signaling in myasthenia gravis.'


'The studies investigating the role of CBD on the treatment of movement disorders are few. Furthermore, differences in the dose and duration of treatment as well as in the stage of the disease (for instance, PD patients are treated only in an advanced stage of the disease) among these studies limit the generalization of the positive effect of CBD and might explain the conflicting results. Notwithstanding, the beneficial neuroprotective profile of CBD added to the preliminary results described here are encouraging. Undoubtedly, future investigations are needed to endorse these initial data and to elucidate the mechanisms involved in the preventive and/or therapeutic potential of CBD on movement disorders.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958190/


'The benefits related to cannabis use in PwMS (People with Multiple Sclerosis) are still under investigation. However, data indicates that cannabis, with 1:1 or greater CBD:THC ratio, reduces muscle spasticity and pain in PwMS. The American Academy of Neurology has highlighted cannabis’ safety profile as well as these benefits. However, there are currently no studies, which investigated the effects of cannabis on mobility in PwMS, some studies have suggested that cannabinoids may exert positive effects on health by decreasing inflammation and decreasing pain. Furthermore, inflammation plays an important role in the generation of MS related fatigue. Specifically, chronic peripheral inflammation and a resulting overactivity of the vagus nerve are related to fatigue in PwMS. There is indirect evidence that reductions in spasticity, pain, and fatigue may result in improvements in the mobility of PwMS.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874292/


'In conclusion, we have demonstrated that the mitigation of EAE with CBD comes from its ability to target a range of anti-inflammatory pathways, including (i) induction of anti-inflammatory MDSCs and (ii) decrease in pro-inflammatory and induction of anti-inflammatory cytokines. Because CBD is non-psychoactive, our studies suggest that CBD may constitute an excellent candidate for the treatment of MS and other autoimmune diseases. Our studies provide further evidence of the importance of MDSCs and that manipulation of such cells may constitute novel therapeutic modality to treat MS and other autoimmune diseases.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085417/


The 21 qualifying conditions for medical marijuana in Ohio includes multiple sclerosis

'The Enquirer set out to determine how many Ohioans could be eligible for medical marijuana under the 21 qualifying conditions from the Ohio Department of Health, the U.S. Centers for Disease Control and Prevention and private nonprofits that raise money for medical research. For many diseases, the numbers of patients are estimates, since the government does not track patient counts for every ailment. The conclusion: About 3.5 million Ohioans deal with at least one of the qualifying conditions. Ohio's population is 11.66 million'
https://www.cincinnati.com/story/news/2018/07/18/3-10-ohioans-eligible-medical-marijuana-card/784017002/


'Dr. Bisasor-McKenzie alluded to the Report of the CARICOM Regional Commission on Marijuana 2018, which states that access to medical marijuana should be facilitated for qualifying conditions in which there is clear evidence of its therapeutic benefits and for debilitating life-threatening conditions that are intractable to treatment, and where there is evidence of possible benefits.

“These include patients on chemotherapy with nausea and vomiting, glaucoma, asthma, anorexia and weight loss in AIDS, cancers, anorexia nervosa, chronic and neuropathic pain, multiple sclerosis, sleep disorders and some neuropsychiatric disorders” she outlined.'
https://jis.gov.jm/health-ministry-supports-conditional-use-of-cannabis-for-research-and-meidicinal-purposes/


'When we reviewed its medical uses in 1993 after examining many patients and case histories, we were able to list the following: nausea and vomiting in cancer chemotherapy, the weight loss syndrome of AIDS, glaucoma, epilepsy, muscle spasms and chronic pain in multiple sclerosis, quadriplegia and other spastic disorders, migraine, severe pruritus, depression, and other mood disorders. Since then we have identified more than a dozen others, including asthma, insomnia, dystonia, scleroderma, Crohn’s disease, diabetic gastroparesis, and terminal illness. The list is not exhaustive.'
http://rxmarijuana.com/old_medicine.htm


'Recently, it (marijuana) has been successfully utilized as an adjunctive treatment for malignant brain tumors, Parkinson's disease (PD), Alzheimer's disease (AD), multiple sclerosis (MS), neuropathic pain, and the childhood seizure disorders, Lennox-Gastaut and Dravet syndromes. In this review, we provide animal/human research data on the current clinical/neurological uses for CBD alone or with Delta9-THC, emphasizing its neuroprotective, antiinflammatory, and immunomodulatory benefits when applied to various clinical situations.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938896/


'The other most common qualifying conditions were spinal cord disease and injuries, followed by traumatic brain injuries and post-concussion syndrome, rheumatoid arthritis and multiple sclerosis.'
http://www.chicagotribune.com/news/ct-met-medical-marijuana-illinois-annual-report-20181004-story.html


'“Several countries permit the use of cannabis for the treatment of medical conditions such as back pain, sleep disorders, depression, post-injury pain, and multiple sclerosis,” the document says. “The evidence presented to the Committee did not indicate that cannabis plant and cannabis resin were liable to produce ill-effects similar to these other substances that are in Schedule IV of the 1961 Convention on Narcotic Drugs. The inclusion of cannabis and cannabis resin in Schedule IV may not appear to be consistent with the criteria for Schedule IV.”'
https://www.marijuanamoment.net/un-launches-first-ever-full-review-of-marijuanas-status-under-international-law/

 

 

'With regard to cannabis products substituting for opioids as pain relief medication, it is considered that the analgesic effects of cannabis are not sufficiently powerful to palliate acute pain or to manage chronic pain. For example, only in very specific cases have preparations containing THC, such as dronabinol and nabiximols, been shown to be effective in the management of neuropathic pain in patients suffering from multiple sclerosis. A long-term longitudinal study among people who were prescribed opioids showed greater pain severity and pain interference (pain effects on sleep, working ability, daily living, social interactions, lower pain self-efficacy and higher levels of generalized anxiety disorder) among the 24 per cent who also used cannabis daily or less frequently than among those who did not use cannabis. Moreover, individuals who used cannabis on a near-daily basis were less likely to discontinue opioid use than participants who abstained from cannabis use' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf