Anecdotally, medical marijuana has been extremely successful for managing symptoms of multiple sclerosis. Researchers now want to find out why.
For the more than 400,000 Americans
suffering from multiple sclerosis ― an autoimmune disease that affects
the brain and spinal cord ― the currently available treatments often
fall woefully short.
There’s no cure for MS, and frequently prescribed immunosuppressant drugs such as corticosteroids
aren’t always effective in addressing common symptoms like weakness,
tingling, numbness, blurred vision and cognitive difficulties. They can
come with significant side effects such as increased risk of infection,
weight gain, emotional changes and high blood pressure.
Increasingly, many people
with MS are turning to medical marijuana to ease their symptoms. A
growing number of anecdotal reports describe the drug’s benefits for
treating common symptoms like fatigue, muscle weakness, anxiety and
sleep deprivation, according to Dr. Thorsten Rudroff, a Colorado State
University neurophysiologist who has conducted research on the effects
of marijuana on multiple sclerosis symptoms. One patient even called
cannabis a “miracle cure” for MS.
But these reports haven’t
yet been verified by scientific research. Scientists have had a hard
time conducting the clinical trials necessary to determine efficacy and
dosing guidelines for the drug because of its status as a Schedule 1 drug.
Medical marijuana is legal
in 28 states and recreational use is allowed in a handful of others, BUT
cannabis research has been heavily obstructed ― even in states where
medical use is allowed.
A National Academies of Sciences report including data from over 10,000 studies, which was published Jan. 12, noted that scientists who want to study cannabis have to seek approval from federal, state and local agencies for their research, and are only able to get their samples from a single lab.
A National Academies of Sciences report including data from over 10,000 studies, which was published Jan. 12, noted that scientists who want to study cannabis have to seek approval from federal, state and local agencies for their research, and are only able to get their samples from a single lab.
Because of these restrictions, Rudroff’s team at the Integrative Neurophysiology Laboratory has been able to conduct only observational studies rather than clinical trials.
In a recent observational
study, Rudroff’s team analyzed data on the health status, symptom
severity and use of medical marijuana from 139 MS patients in Colorado
who were already using cannabis.
The results showed that the majority of users showed fewer signs of neurological disability, and they were also able to reduce or discontinue their use of other medications as a result of their cannabis use.
The results showed that the majority of users showed fewer signs of neurological disability, and they were also able to reduce or discontinue their use of other medications as a result of their cannabis use.
The Scope caught up with
Rudroff to learn more about the potential of cannabis for treating
multiple sclerosis, and why the drug has been so difficult for
scientists to study.
What are the most
striking findings so far from your studies on patients who have been
using cannabis to treat their MS symptoms?
Our experience here is that
these patients reported less pain, less muscle spasticity compared to
other patients with multiple sclerosis.
Also, we looked at some
physical functions, and they performed better. These patients were
stronger in the legs, they were less fatigable, and they also showed
better balance. These are some of the preliminary findings we’ve had so
far, but of course we need more subjects to validate this and to make
sure that this is really an effect of cannabis.
I have a lot of interactions
with these patients, and they have reduced other medications, they have
less pain, they are more physically active. It’s very exciting for me.
Do we have a sense
of why, at least anecdotally, cannabis seems to work so well for MS
symptoms? Is it that the drug is acting as an anti-inflammatory agent?
The exact mechanisms we
don’t know, and this is what I want to find out. Some people say it’s
anti-inflammatory, but we don’t know.
Another study we are doing
right now is using brain imaging. So we look at some patients with MS
who are regularly using cannabis, and put them into a PET/CT scanner to
investigate which brain areas are more or less active. Then, we can say
something about what the mechanisms are here. This is an ongoing study
that we just started here.
What are the most common currently available treatment options for MS? What are some challenges with current treatments?
Well, many patients have
pain, so they are using opiates, for example. Opiates have many side
effects ― you can get addicted to these dangerous drugs and often they
are not even working very well.
I know many patients who stopped using opiates and switched to cannabis products, and this is working much better for them.
I know many patients who stopped using opiates and switched to cannabis products, and this is working much better for them.
And in many cases, when the
patients start taking cannabis, they don’t stop using the other
medication. They are using these other kinds of drugs in addition to
cannabis. The problem is that we don’t know the interactions between all
the drugs, and this is an area that needs further research. Usually
these patients are using many drugs at the same time.
There’s a clear need
for more research, as you suggest. So why is it so difficult for
scientists to conduct trials using medical marijuana?
The thing is that it’s a
Schedule 1 drug, so it’s at the same level as heroin and all these other
dangerous drugs. We’re not allowed to do intervention studies ― I can’t
give patients cannabis, and I can’t tell them how to use cannabis. You
need a special license to do this, which I applied for from the Drug
Enforcement Administration and hopefully will get within the next year
so that then I can do these intervention studies. Right now, I can only
do observational studies. So I invite patients who are currently using
cannabis to the lab for some experiments.
It’s difficult to give this
drug to patients. It takes time and lots of special requirements are
there. For example, we have to order the products from the National
Institutes of Health, then we have to have a safe room to lock them in.
There are very strict rules.
There are so many promising
results out there, so why is it still a Schedule 1 drug? Why has it not
been reclassified to Schedule 2? I really don’t know.
What do we know
about the importance of THC versus CBD [the two main active compounds in
marijuana] when it comes to treating MS symptoms?
My impression right now is
that THC has more of the psychoactive effects, and the medical benefits
are coming from the CBD (cannabidiol). So right now, I’m thinking the
more CBD, the better in a cannabis product.
CBD binds to the receptors
in the human body and alters the way the receptors act to our body’s
natural signals. In MS, we have too much activity of the immune system.
CBD may inhibit this increased activity, which may result in the medical
benefits.
What needs to happen for doctors to be able to prescribe medical cannabis to patients who need it?
We’re getting closer and
closer. In Colorado, doctors can provide the patients with a medical
card, and then the patients can go to the shop and buy these products.
But what we need is more guidelines for these patients. They don’t know
how much they should take, the best ratio of THC to CBD, or how often
they should take it. Should they smoke cannabis or use edibles?
These are all things we have
to figure out, and then doctors can prescribe cannabis and give their
patients proper guidelines. Right now it’s all self-medication, and that
can be dangerous.
For example, some patients are using cannabis with opioids and we don’t know the interactions between these drugs. We really need some guidelines to provide these patients.
For example, some patients are using cannabis with opioids and we don’t know the interactions between these drugs. We really need some guidelines to provide these patients.
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