MS and Weed: Treating Multiple Sclerosis

by Adam Rhodes

Multiple sclerosis (MS) is a chronic degenerative disease.

It affects the central nervous system and causes inflammation, muscular weakness and a loss of motor coordination. As MS progresses, the patients typically become permanently disabled. In extreme cases this can be so severe that it causes patient death.

The US National Multiple Sclerosis Society estimates that 200 people are diagnosed with the disease each week. MS most often strikes individuals between 20 and 40 years old but has been seen appearing across the age spectrum. Because of the symptoms of MS, it is recognized by all states as a qualifying condition for medical marijuana.

Efforts have been made to protect medical patients from federal punishment.

Although marijuana is still federally illegal, legislation passed in 2015 clarified that the federal government would no longer use federal funds to enforce federal marijuana laws. This included states that permit medical marijuana use. The legislation was an effort to reduce confusion about federal intervention in states that legalized use.

The directive effectively overturned the Supreme Court’s 2005 ruling which said the federal government could prohibit and prosecute the possession and the medical use of marijuana. The court also ruled that state laws did not protect medical users from prosecution. The legislation was careful to ensure that if White House later chooses to reverse the federal directive, it can.

Cannabis isn’t the only treatment out there but it is one of the best.

Most agree that better therapies are needed to treat the symptoms of MS (since there is no cure) which include pain, tremors and spasticity. Current pharmaceutical options may not sufficiently treat the symptoms of MS but there are about the benefits of marijuana relative to its side effects.

The National Multiple Sclerosis Society is one of the biggest non-profit names in MS. Over the years, they have proven to be allies of patients as they fought to help promote awareness and access to new and alternative treatments.

On their website the Society claim to support:
“the rights of people with MS to work with their MS health care providers to access marijuana for medical purposes in accordance with legal regulations in those states 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.”

We know a lot about treating MS with cannabis.

There have been tons of studies on effects of cannabis on cognition / cognitive function in people with MS. Two of which stand out as examples of the common outcomes for treatment with cannabis.

While both were published in the journal Neurology, the first was in 2012 and the second was 2014.

In the 2012 study, 25 MS patients who regularly smoked or ingested street cannabis were tested and results compared to 25 MS patients who didn’t use cannabis. The users were tested at least 12 hours after last using to minimize intoxication.

The 2014 study used 20 MS patients who smoked cannabis and 19 who didn’t. 

They matched them based on demographics and neurological variables before undergoing magnetic resonance imagining(fMRI). The scan revealed brain activity while performing tasks and tested their working memory. As memory tasks became more demanding, cannabis users performed increasingly worse than their non-using counterparts.

Cannabis users performed significantly worse on measures of information processing speed, working memory, executive functions and other cognitive functions than non-users. In addition, they were twice as likely as nonusers to be considered cognitively impaired. The study showed that cannabis can worsen cognitive problems in MS.

Cannabis doesn’t have to be smoked to be medically beneficial.

Participants in another study with stable MS were randomly assigned to receive oral cannabis extract.  The test group consisted of 144 using cannabis and 135 on a placebo. Participants reported their perceptions of changes in muscle stiffness.

The administrators tested participants both before and after 12 weeks of treatment. They found that muscle stiffness had improved almost twofold in the group taking cannabis compared to placebo.

Patients also reported improvements in body pain, spasms and sleep quality.

Contrary to popular belief, using cannabis did come with some negative side effects. While only a percentage of the population, the study noted increased risk/frequency of urinary tract infections, dizziness, dry mouth and headache. These side effects should not be news to anyone who has used cannabis before and the team reported observing no new safety concerns.

No discussion would be complete without mentioning Nabiximols.

Nabiximol is an oral spray derived from cannabis marketed as Sativex by GW Pharmaceuticals. Available in 15 countries and approved in 12 more (excluding the US), Sativex is used to treat MS-related spacity. It significantly improved spasticity in a proportion of the population with MS who had been identified as likely to respond to the therapy.

The Journal of Neurology, Neurosurgery & Psychiatry reported on a long term study on the safety of cannabinoids in MS. The study used 630 subjects with stable MS and muscle spasticity from 33 centers around the UK and randomly assigned some to receive oral THC, cannabis extract or a placebo.

Over the course of 15 weeks, the oral derivatives did not provide objective improvement to the subjects according to a standardized assessment tool. When it came to subjective improvement though, there were significant improvements in spasticity and pain. Even though the tremor and bladder control symptoms did not seem to respond to the treatment, people felt better.

A study has to be ready for some complications.

Basically, when participants report feeling improvements that cannot be confirmed by the physicians, there is a problem. This could be dealt with normally but the Nabiximol study became unblinded.

The side effects of THC made it clear to patients they were receiving the active drug rather than the placebo.

In another study published by Lancet Neurology during 2013, they tested orally administered dronabinol. The test group consisted of 493 patients with 329 receiving at least one dose while 164 received at least one dose of placebo. The results showed that dronabinol had no overall effect on MS progression.