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Medical Marijuana for Multiple Sclerosis: What Does the Research Say?

By Alexander Beadle

Published: Oct 07, 2019   
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Multiple Sclerosis, or MS, is a neurological condition that affects the brain and the spinal cord. It arises when a person’s immune system starts to target and attack the body’s own nerves instead of external infections. This can manifest in symptoms such as fatigue, vision problems, muscle spasms, and problems with co-ordination and cognition.

Around 2.5 million people worldwide are thought to be affected by the lifelong condition, and each individual case can be vastly different; the condition sometimes results in serious disability, and other times only causes a mild concern. In many cases, it’s possible to treat and alleviate specific symptoms or flare-ups using steroids, courses of physiotherapy, antidepressants, and muscle relaxants.

However, infrequent steroid treatments can lead to osteoporosis, weight gain, and diabetes. The antidepressants and muscle relaxant medications usually prescribed also come with their own set of side effects, including nausea, weakness, diarrhea, and dizziness.

Medical cannabis has been touted as a potential alternative therapy for MS sufferers, one that could treat the muscle stiffness and spasms associated with MS without causing the same dramatic side effects. But is there any scientific basis behind this claim?


Marijuana and MS, a clinical trial

Sativex, the brand name for the nabiximols drug produced by the British company GW Pharmaceuticals, is one of the most widespread and popular cannabis-derived drugs intended for treating MS. The drug is an oromucosal spray containing a 1:1 ratio of THC and CBD, as well as some other minor cannabinoids and non-cannabinoid active ingredients.

To date, it has received regulatory approval and marketing authorization in over 25 countries – including the United Kingdom, Norway, Brazil and Australia – for the treatment of MS-related muscle stiffness and spasms.

As a part of Sativex’s development, GW Pharmaceuticals has sponsored numerous clinical trials studying its effects on the symptoms of MS, with specific focus given to any improvements in spasticity (muscle stiffness/spasms), neuropathic pain, and bladder control.

The study into Sativex’s effect on neuropathic pain found that patients on average were self-administering around 22-32 mg/day of THC and 20-30 mg/day of CBD to manage their pain. At these doses, Sativex showed positive results in the placebo-controlled trials where it was used as an add-on therapy.

More than ten different studies and clinical trials have so far studied Sativex’s effect on MS-related spasticity. One of the earliest, a 2005 study of over 360 patients with various neurological conditions (including MS), found that the Sativex spray “significantly reduced neuropathic pain, spasticity, muscle spasms, and sleep disturbances.”

Another study – this time a 2012 placebo-controlled, parallel-group, randomized withdrawal study of patients receiving long-term Sativex for controlling MS spasticity – concluded that Sativex’s “efficacy in long-term symptomatic improvement of spasticity to a group of subjects with MS has been confirmed.”

A 2010 meta-analysis, which reviewed the results of three randomized, placebo-controlled, double-blind parallel group studies, also concluded that Sativex “is well tolerated and reduces spasticity” in people with MS.


Cannabis and MS, further scientific evidence

In 2017, the National Academies of Sciences, Engineering, and Medicine published a report containing nearly 100 different conclusions on the health effects of cannabis and cannabis-derived products.

The report, which considered the results of more than 10,000 scientific studies covering all areas from cancer treatment to mental health to therapeutic effects, found that there was inconclusive evidence to reach proper judgements on whether cannabis can effectively treat most of the medical conditions that it has been claimed to help.

From all of the different medical areas studied, only three showed any concrete evidence that properly supported medical cannabis treatment: reducing chemotherapy side effects, treating chronic pain, and treating MS spasticity.

“For adults with multiple sclerosis-related muscle spasms, there was substantial evidence that short-term use of certain ‘oral cannabinoids’ – man-made, cannabinoid-based medications that are orally ingested – improved their reported symptoms,” states the report.  

Most recently, a 2018 systematic review-of-reviews noted that “high quality reviews [have found] cannabinoids may have modest effects in MS for pain or spasticity”, and a 2019 comprehensive review looking at advances in the management of chronic pain in MS concluded that medicinal cannabis treatments, as well as targeted physical therapy and neuromodulation “offer promising results.”


Anecdotal evidence

With drugs such as Sativex now available through the legal medicinal cannabis market, there is also a growing wealth of anecdotal evidence that speaks to the effectiveness of medical cannabis as a treatment for various symptoms associated with MS.

Writing in a column for the health and wellness website Healthline, Meg Lewellyn describes her experience with using medical cannabis for her MS.

After being diagnosed in 2007, Lewellyn tried a variety of doctor-prescribed medications to try to manage her symptoms, but found no relief. In 2013, she was prescribed medical cannabis by her doctor. But concerns over the stigma of the drug led her to forgo the treatment until 2016.

“Medical marijuana is helping, and that is what matters. I am extremely optimistic that I will continue to find relief,” she wrote. “Unlike many of the prescribed medicines I have tried in the past, I haven’t run across any side effects [with cannabis].”

Lewellyn is now a medical cannabis educator and speaker, and runs a “cannabis retreat” in Washington state, which offers educational programs and seminars about the safe cultivation and use of cannabis.

Alexander Beadle

Science Writer

Alexander Beadle has been working as a freelance science writer since 2017 and has covered the cannabis industry for Analytical Cannabis since 2018. He has also written for our sister publication, Technology Networks, and the cannabis industry consultant firm Prohibition Partners, among others. Alexander holds a Master's in Materials Chemistry from the University of St. Andrews, where he won a Chemistry Purdie scholarship, and conducted research into zeolite crystal growth mechanisms and the action of single-molecule transistors.


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