Medicinal cannabis, Sativex and treatments for spasticity in MS

Earlier this week our Director of Service Development, Amy Bowen, was asked by a national paper to comment on the issue of medicinal cannabis in MS, and in particular Sativex, a drug used to treat muscle spasticity. When published, Amy’s interview was edited down to a couple of lines in a larger article. Here she explores some of the difficult issues around cannabis use in MS in more depth

Muscle spasticity is muscle stiffness or spasms. If you experience spasticity, your limbs might feel stiff, heavy or difficult to move. Another way of understanding spasticity is having too much tone in your muscles. They put up needless resistance when you try and move them, rather than being flexible. As I write these words, I am acutely aware that they probably don’t really scratch the surface of how difficult it can be to cope with spasticity. Limbs that won’t cooperate can make lots of daily activities a big chore. Muscle spasticity can also be very  painful and, confusingly, limbs can feel both tight and weak at the same time. We have a video which explains this really well.

How spasticity can be treated
There are drugs to treat spasticity, and these are relatively easy to access. Many MS nurses can prescribe them, as can GPs, neurologists or rehabilitation physicians. They are not without side-effects though, and if you have taken any of these medications, you might have experienced effects like drowsiness or dizziness. You might have found the side-effects outweighed any benefit you got from the drug or they may have been an acceptable price to pay for better control of your spasticity.

Drugs are not the whole answer for dealing with spasticity and there are many other ways that you can get more control. Physiotherapists who specialise in neurology are particularly helpful in improving how you cope with and manage your spasticity and can help with identifying what triggers your spasticity and how to avoid these triggers where possible.

Where does medicinal cannabis fit into treating spasticity?
But what does all this have to do with cannabis? If your spasticity is more severe and the drugs that are usually used as the first choice for treatment don’t control your symptoms or if the side-effects cause too many problems, there is another alternative, at least in theory. Sativex is a cannabis-based drug which can only be prescribed by a specialist doctor when other treatments for spasticity have been tried. It is not widely available and indeed NICE has not recommended that it is made available on the NHS in England because they consider that it is not cost effective. It is also not available in Scotland. It is available in Wales, however.

Over the years, some people with MS have opted to treat symptoms such as muscle spasticity by illegal use of cannabis. Sativex, as a cannabis based drug, was viewed by many as being a legal alternative which could deliver a similar benefit in improving spasticity. In reality, the drug is not used as a first choice for treating spasticity, not everyone benefits from the drug and no drug on its own will fully resolve problems with spasticity. Support from therapists such as physios and developing good strategies for managing your triggers will always be a key part of getting your spasticity as well controlled as possible.

Where we stand
The plain fact is that cannabis is an illegal drug. We don’t encourage or condone the use of an illegal drug but we recognise that it’s a personal choice, like all our health and lifestyle choices. We know that limited access to Sativex may influence some people with MS to source cannabis in other ways and this is what troubles us most. Given that it’s possible to know within a relatively short time (about a month) whether someone will benefit from Sativex, and given that it will only ever be suitable for people whose spasticity is not controlled with the first choice drugs, we feel that its reasonable that, for this small number of people, Sativex is available as an option on the NHS. That way it can be appropriately and safely used. It might also help reduce illegal use of cannabis with all the risks involved.

If you are struggling with muscle spasticity, we strongly encourage you to seek support from your MS team. This could be your MS nurse, physiotherapist, occupational therapist or your neurologist. They can help look at your spasticity in terms of your MS overall and the other symptoms you might be experiencing. Spasticity is a difficult problem and the answer lies in using a range of strategies, which might include having a drug prescribed. Most importantly, we hope you don’t struggle on alone. Seek information and support from sources like the   MS Trust, and contact your MS team for help.