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Multiple sclerosis
Multiple sclerosis is a degenerative condition that affects the nerves in the central nervous system. There is currently no cure. Marijuana (cannabis) may be useful for treating several symptoms of the condition.
Multiple sclerosis (MS) is a serious and lifelong condition that causes a range of symptoms.
In people with MS, the immune system is overactive and causes damage to cells in the brain, spinal cord, or optic nerves that make up the central nervous system.
Marijuana, which is also known as cannabis, is now legal in many areas of the United States.
The term “cannabis” is preferable to marijuana, as the latter term has racist roots and connotations.
The National Multiple Sclerosis Society supports the use of medical cannabis for people with MS in some instances and where it is lawful.
According to a 2018 reviewTrusted Source, cannabis products were generally well-tolerated, and serious adverse effects were rare. However, adverse effects may occur, and cannabis may not be suitable for everyone.
More research is necessary before the Food and Drug AdministrationTrusted Source (FDA) can approve its use for MS.
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The chemicals in cannabis have different effects on the body, some of which can be medicinal.
Tetrahydrocannabinol (THC) is one of the primary chemicals in cannabis, and it has psychoactive properties that cause the “high” of the drug. Conversely, a compound called cannabidiol (CBD) does not have psychoactive effects. There are many other components of cannabis, but most research to date has focused on these two.
THC mayTrusted Source increase appetite, reduce nausea, and improve muscle control issues.
CBD may be useful for controlling some types of epileptic seizures and is a promising option for some mental health conditions such as social anxiety and PTSD.
CBD is also a promising option for helping with pain and spasticity.
More evidence is needed to determine the therapeutic potential of CBD and to determine safe and effective dosages for each use.
People should check on their local laws before using cannabis or cannabis products.
Seek guidance from a healthcare provider, if possible, before using any CBD products.
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In a 2012 study in the UK, researchers gave 279 people with MS either an oral extract of cannabis or a placebo for 12 weeks. The extract was taken from Cannabis sativa L and the main cannabinoid was THC.
The researchers found that people in the cannabis group experienced almost twice as much relief from muscle stiffness.
A 2014 systematic reviewTrusted Source published by the American Academy of Neurology (AAN) found strong evidence to support the use of cannabis-based treatments for MS-related muscle problems.
This review found that oral cannabis extract (OCE) does help with muscle spasms, while THC probably does not help.
A 2010 analysisTrusted Source of three studies (666 participants in total) on the use of nabiximol (Sativex), a cannabinoid-derived mouth spray, by people with MS and spasticity found that it reduced subjective spasticity.
A 2018 reviewTrusted Source looked at 11 reviews of cannabis and cannabinoids’ use in treating symptoms of MS. Five of the 11 reviews concluded that there is enough evidence that cannabis can help with muscle spasticity.
A 2012 trialTrusted Source looked at the effect of smoking cannabis on the symptoms of MS. The researchers found that smoking cannabis led to more pain reduction than a placebo.
In another 2012 study, people with MS who took a THC oral cannabis extract had a more significant reduction in pain than those who received a placebo.
If someone with MS experiences aches in their muscles and joints, topical CBD could help.
A 2016 studyTrusted Source on a rat with induced arthritis found that topical CBD, applied for four consecutive days, significantly reduced joint swelling and inflammation.
While cannabis appears to helpTrusted Source relieve pain in some people with MS, there is not yet enough research to know which form or balance of CBD and THC is most effective.
There are not enough studies on CBD, taken orally, to prove its effects on pain relief.
Scientists conducted a trialTrusted Source to investigate the use of the oral cannabis extract nabiximols (Sativex) for bladder dysfunction.
They gave the participants either the extract or a placebo for 10 weeks.
The results were not statistically significant, but they indicated that cannabis might improve the symptoms of bladder problems in people with MS.
The 2014 AAN reviewTrusted Source also found evidence to suggest that oral cannabis extract is likely to be effective for treating these issues.
Cannabis is unlikely to be beneficial for reducing tremors, another primary symptom of MS.
The 2014 AAN reviewTrusted Source found that the existing evidence did not support the use of cannabis to reduce tremors in people with MS. However, it is still possible that cannabis might be useful for the treatment of tremors in people with conditions other than MS.
Guidelines from the American Academy of Neurology for people with MS state that oral cannabis extracts, synthetic THC, and oral cannabis sprays are likely to be effective for treating some MS symptoms. They note that it is unclear whether smoking cannabis may also be beneficial.
Also called “medical marijuana,” medical cannabis is cannabis and cannabinoids (chemical compounds in the plant) that can be medically recommended to treat certain conditions and symptoms, such as nausea and vomiting associated with chemotherapy, and pain that can be associated with numerous conditions
Cannabinoids are the chemical compounds secreted by cannabis flowers. There are also compounds called terpenes – chemical compounds that give cannabis its unique aroma. The concentrations and combinations of the cannabinoids and terpenes vary from plant to plant and among the different strains of cannabis. When inhaled, consumed as an edible, or used on the skin as a topical preparation, the cannabinoids bind to cannabinoid docking sites or receptors in the human body and alter nerve transmission in the brain
The two major cannabinoids in cannabis that have been studied are: • THC (tetrahydrocannabinol, also known as delta-9-tetrahydrocannabinol), is thought to be the most psychoactive substance (i.e., a substance that changes brain function and alters perception, mood, consciousness or behavior) in cannabis. The concentration of THC in cannabis varies between 1% and 24%. • CBD (cannabidiol) is the major non-psychoactive cannabinoid found in cannabis. The concentration of CBD in cannabis is typically less than 1%, but many strains have higher CBD concentrations.
Botanicals are a variety of cannabis products that are derived from the cannabis plant. Cannabis can be taken via inhalation (smoked plant or vaporized extracts), orally (oils, tinctures, extracts, “edibles”), or as a topical application (lotions and salves). These products vary in their concentration and proportions of cannabinoids and may be labeled with this information.
Synthetic cannabinoids are compounds that made in the laboratory rather than from the plant. The FDA has approved 2 synthetic cannabinoid products with specific rules for prescribing:
• Dronabinol (Marinol®) –consists of synthetic THC suspended in sesame oil and sold in capsules approved for the treatment of chemotherapy–induced nausea and vomiting and as an appetite stimulant in patients with AIDS.
• Nabilone (Cesamet®) – mimics THC and comes in capsules for the treatment of chemotherapy–induced nausea and vomiting
There have been numerous studies conducted to evaluate the effects of cannabinoids on MS- related pain, spasticity, and bladder symptoms. Most studies involved relatively small numbers of people with MS and the outcome measures varied among studies. However, reviews of published studies have generally shown that synthetic cannabinoids favorably impact symptoms of pain and spasticity. Less is known about the impact of inhaled or ingested botanical cannabis on MS symptoms.
For more information about research evidence in MS download the 2017 Cannabis summary.
There are side effects associated with the use of botanical cannabis and synthetic cannabinoids including: mental confusion, cognitive impairment, anxiety and/or paranoia, nausea, vomiting, dry mouth, dry eyes, sedation, increased appetite, headache, impaired balance and coordination, and elevated heart rate. There are also potential risks to the lungs if cannabis is smoked.
Laws and rules vary from state to state. For up-to-date information on state laws, it is best to check with the individual state government or the non-profit organization
Currently cannabis is federally designated as a schedule 1 drug, making it federally illegal to
transport cannabis on flights, or across state lines. For more information, visit Americans for
Safe Access online.
The Society supports the rights of people with MS to work with their health care provider to access cannabis for medical purposes in accordance with legal regulations in those states where such use has been approved. In addition, the Society supports the need for more research to better understand the benefits and potential risks of cannabis and its derivatives as a treatment for MS and its symptoms.
By Federal law it is unlawful to manufacture, distribute, dispense, or possess with intent to distribute or dispense cannabis. However, since 2014 Congress has passed language through annual appropriations bills known as the Rohrabacher–Farr Amendment to reduce uncertainty around state laws governing the use of medical cannabis. This amendment prohibits the Department of Justice from using funds to prevent states which have passed medical cannabis laws from implementing those laws that authorize the use, distribution, possession, or cultivation of medical cannabis.
This language effectively prohibits the Department of Justice from enforcing the Controlled Substances Act as it applies to medical cannabis
The National MS Society supports the ability of people living with MS to make informed choices about their treatments with their MS health care providers, including the use of medical cannabis. Recognizing that additional research is still needed, we are evaluating ways we can remove the barriers to allowing research on medical cannabis at the federal level. We advocate legalizing medical cannabis at the state level.
In 2014, the American Academy of Neurology (AAN) released a “Summary of evidence–based
guideline: Complementary and alternative medicine in multiple sclerosis.” The guideline was
created by a panel of medical experts who evaluated all published research studies. Among
studies of several forms of cannabis and its derivatives evaluated by the panel, evidence
suggests:
• Oral cannabis extract and synthetic THC (tetrahydrocannabinol—a major active
component of cannabis) are probably effective for reducing patient-reported symptoms of
spasticity and pain, but not MS-related tremor or spasticity measurable by tests
administered by the physician.
• Sativex oral spray (GW Pharmaceuticals) is probably effective for improving patient-
reported symptoms of spasticity, pain and urinary frequency, but not bladder
incontinence, MS-related tremor or spasticity measurable by tests administered by the
physician.
The AAN findings state that smoked cannabis research studies have not produced enough evidence to assess its safety or effectiveness for treating MS symptoms including spasticity, pain, balance, posture and cognition changes.
The AAN further notes: “Oral cannabis extract, THC and Sativex are not currently approved by the FDA for use by people with MS. The FDA has approved only two forms of marijuana for medical use: dronabinol (Marinol) and nabilone (Cesamet). Dronabinol also is approved for loss of appetite associated with weight loss in patients with AIDS. At this time, the drugs are not approved for other uses.
Cannabis is a complex substance which may contain many different components affecting the body. Production of marijuana for medical use is not standardized or supervised by the FDA or any other agency for its quality, purity, or specific ingredients, hence, the effects of different batches of marijuana may not be the same.”
The guideline notes that cannabis usage, as with any therapy, may result in both potential benefits and potential side effects. For these cannabis derivatives, the most commonly reported side effects were dizziness, drowsiness, difficulty concentrating and memory disturbance. The guideline also points out that the long-term safety of cannabis use for MS symptom management is not yet known.
Multiple sclerosis (MS) is a neurologic disease of the central nervous system that causes physical and cognitive disability. Multiple sclerosis is also associated with a diverse range of symptoms, including pain, spasticity, fatigue, balance problems, heat intolerance, bladder problems, and tremors, all of which adversely affect quality of life.1 Patients with MS often seek nonmainstream treatment options to alleviate their symptoms, such as complementary and alternative medicine (CAM), herbal supplements, and marijuana.
Social perceptions and attitudes regarding marijuana use in the United States have shifted in the past decade. Jones et al4 in 2015 reported that 58% of Americans favored legalization of marijuana, compared with 30% in 2000. The political and legal environment for marijuana use has also changed considerably, particularly in the United States, in part because the legal sale of marijuana is seen as a potential source of tax revenue and in part because of shifting social attitudes among the voting public.4 Marijuana use for medical and recreational purposes is now legal in Colorado, Washington, California, Oregon, Alaska, Massachusetts, Maine, and Nevada, all of which have legalized marijuana use via referendum or legislation.5 Medical marijuana has also been legalized in 29 states.5 However, marijuana is still considered an illicit substance under US federal law.
The US Food and Drug Administration (FDA) has approved two drugs, dronabinol and nabilone, the active ingredients of which are synthetic derivatives of delta-9-tetrahydrocannabinol (THC), the main psychoactive agent in marijuana.6 Dronabinol is FDA-approved for treating AIDS-associated anorexia and chemotherapy-induced nausea and vomiting.6 Nabilone is FDA-approved for the treatment of nausea and vomiting caused by cancer chemotherapy in patients who do not respond adequately to conventional antiemetic medications. Nabiximols is an oral mucosal spray containing THC and cannabidiol that has been approved in Canada and the United Kingdom for neuropathic pain, spasticity, and overactive bladder7; however, nabiximols is not approved in the United States. In two phase 3 trials, nabiximols did not improve average self-reported numerical rating scale pain scores in patients with cancer.
The American Academy of Neurology lists oral cannabis extracts as a level A effective treatment for symptoms of spasticity and pain (excluding central neuropathic pain).3,8 There is level B evidence that oral cannabis extracts are probably ineffective for signs of spasticity and tremor.3,8 Synthetic THC is listed as a level B effective treatment for symptoms of spasticity and pain (excluding central neuropathic pain).3,8 Nabiximols is listed as a level B effective treatment for symptoms of spasticity, pain, and urinary frequency.3,8 There is level B evidence that nabiximols is ineffective for signs of spasticity and urinary incontinence, and level C evidence that nabiximols is ineffective for tremor
Factors associated with marijuana use to treat symptoms of MS have not been extensively researched in the United States. Chong et al9 investigated marijuana use in patients with MS seen at two outpatient neurology clinics in the United Kingdom (n = 254) and found that 43% of patients reported ever use of marijuana. Of the ever users, 68% reported using marijuana to alleviate symptoms of MS.9 In another study by Page et al,10 43% of survey respondents with MS (n = 420) in Canada reported ever use of marijuana and 16% had tried marijuana for medical purposes. Banwell et al11 reported a 54.3% acceptance rate for the legalization of medical marijuana among Canadian patients and found that sleep, pain, anxiety, and spasticity were the most common reasons for marijuana use.
The main goal of this study was to investigate the prevalence of marijuana use in patients with MS compared with controls. Another goal was to investigate the associations between marijuana use and clinical factors, such as MS disease course, use of disease-modifying therapies (DMTs), and disability level, and demographic characteristics, such as education level, smoking status, and CAM use.