Medical Cannabis For Multiple Sclerosis

Multiple Sclerosis (MS) is a painful disease that needs better treatment than what is conventionally available (just one of many such diseases). In the United States (US), The National Multiple Sclerosis Society says that development of more treatments for symptoms of the disease is one of its priorities. The Society goes on to say that despite the uncertainties of cannabis benefits, it supports MS patients' rights to work with care providers to access medical cannabis in US states where it is approved. The Society also supports further research to learn more about the benefits and any potential risks.

In Australia, in their recent submission to the Senate Legal and Constitutional Affairs Legislation Committee Inquiry into the Regulator of Medicinal Cannabis Bill 2014, MS Australia (MSA) and MS Research Australia stated they were committed to supporting the provision of proven therapies for improving the lives of people with MS, and that they would continue to monitor the debate regarding cannabis use for medical purposes and their potential impact on people affected by MS;

"... our policy on these issues is guided by a scientific, evidence-based approach and we would advocate for a regulatory framework that will facilitate further clinical trials to determine the components, dosage and frequency of cannabis-based products and their effectiveness in managing a range of symptoms for people living with chronic conditions like MS. MSA and MS Research Australia would welcome products such as Sativex® being made available for people with MS in Australia, if regulations regarding access to clinically proven cannabis-derived products were to change."

In late 2012 the medicinal cannabis based mouth spray Sativex® was listed for use for people with Multiple Sclerosis (MS) with muscle spasticity by the Therapeutic Goods Administration (TGA) in Australia. MSA says of Sativex®;

"... it is important to note however that Sativex® does have side effects that will vary with each case. These can include dizziness, tiredness, depression, memory loss and nausea."

In July 2013 both MSA and MS Research Australia wrote to the Pharmaceutical Benefit Advisory Committee (PBAC) secretariat in support of the inclusion of Sativex® on the Pharmaceutical Benefits Scheme (PBS), although this application was not approved.

In an article earlier this year in The Medical Journal of Australia, by David G Penington (University of Melbourne, Victoria) he points out that the debate about the medical use of cannabis in Australia has become confused with the proposal for a formal clinical trial instead of proceeding to legislation in New South Wales (NSW), the Australian Capital Territory (ACT) and Victoria. Debates about prohibition of cannabis have a long history, as has the proposal for medical cannabis in Australia. Politicians are nervous about being 'soft on drugs' but the clinical trial proposed, if successful, presumes that cannabis would then be approved and regulated as a pharmaceutical substance. Cannabis can never be a pharmaceutical agent in the usual sense for medical prescription, as it contains a variety of components of variable potency and actions, depending on its origin, preparation and route of administration. Consequently, cannabis has variable effects in individuals. It will not be possible to determine universally safe dosage of cannabis for individuals based on a clinical trial.

While there is a plethora of anecdotal claims to draw from to suggest that cannabis in general eases pain, a clinical study at the University of California (UC San Diego) backed up the claim in 2012. The study of adults with MS showed that smoked cannabis may be an effective treatment for spasticity, a common and disabling symptom of this neurological disease. The placebo-controlled trial also resulted in reduced perception of pain, although participants reported short-term, adverse cognitive effects and increased fatigue. They found that smoked cannabis was superior to placebo in reducing symptoms and pain in patients with treatment-resistant spasticity, or excessive muscle contractions. Earlier reports suggested that the active compounds of medical cannabis were potentially effective in treating neurologic conditions, but most studies focused on orally administered cannabinoids. There were anecdotal reports of MS patients that endorsed smoking cannabis to relieve symptoms of spasticity.

However, this trial used a more objective measurement which graded the intensity of muscle tone by measuring such things as resistance in range of motion and rigidity. The secondary outcome, pain, was measured using a visual analogue scale. The researchers also looked at physical performance, cognitive function and asked patients to assess their feeling of 'highness'. Although generally well tolerated, smoking cannabis did have mild effects on attention and concentration. The researchers noted larger, long-term studies are needed to confirm the findings and determine whether lower doses can result in beneficial effects with less cognitive impact. Four other human studies on control of neuropathic pain also reported positive results and added to the growing body of evidence that cannabis has therapeutic value for selected indications and may be an adjunct or alternative for patients whose spasticity or pain is not optimally managed.

Some of the side effects that occur from taking pharmaceutical drugs for treating MS can include stress, depression and fever, any of which can last for months. But medical cannabis can be used to reduce these factors as well as giving patients an overall sense of well-being. Thanks to medical cannabis, MS symptoms such as muscle spasms, tremors and effects on speech and vision can also be relieved. Other common side effects which cannabis can relieve include dizziness, headaches and fatigue.

Some patients who appear to be bound for wheelchairs have claimed that cannabis helps them walk. A study in the US and UK in the late 1990's of 112 MS patients published by the European Journal of Neurology found that 70% of respondents who used cannabis claimed improvement in several symptoms. Weakness in legs was one of the symptoms, along with pain in legs and spasticity when walking. A study in 2009 by the Global Neuroscience Initiative Foundation suggested that cannabis helps improve mobility among MS patients. Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review, reached the conclusion;

"We found evidence that combined THC and CBD extracts may provide therapeutic benefit for MS spasticity symptoms. Although some objective measures of spasticity noted improvement trends, there were no changes found to be significant in post-treatment assessments. However, subjective assessment of symptom relief did often show significant improvement post-treatment. Differences in assessment measures, reports of adverse events, and dosage levels are discussed."

Numerous studies have also shown the efficacy of medical cannabis in treating neuropathic pain, which is the most common pain type experienced by patients with MS. For example; Low-dose vaporised cannabis significantly improves neuropathic pain; a double-blind, placebo-controlled, crossover study was conducted evaluating the analgesic efficacy of vaporised cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Patients with central and peripheral neuropathic pain underwent a standardised procedure for inhaling medium-dose (3.53%), low-dose (1.29%) or placebo cannabis. Psychoactive side effects and neuropsychological performance were also evaluated. Mixed-effects regression models demonstrated an analgesic response to vaporised cannabis. There was no significant difference between the 2 active dose groups' results. The results were comparable to those of traditional neuropathic pain medications; cannabis has analgesic efficacy with the low dose being as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well tolerated, and neuropsychological effects were of limited duration and readily reversible within 1 to 2 hours. Vaporised cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. The analgesia obtained from a low dose of delta-9-tetrahydrocannabinol (THC [1.29%]) in patients, most of whom were experiencing neuropathic pain despite conventional treatments, is a clinically significant outcome. As a result, one might not anticipate a significant impact on daily functioning.

In the past few years, studies into MS and cannabis have exploded. Granny Storm Crow's List has hundreds of links to everything cannabis from scientific papers through to blog posts and anecdotal articles. PubMed comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals and online books as part of the US National Library of Medicine. Google Scholar is another resource for finding scientific, medical research and information, online. One thing that MS and cannabis have in common is the medical community, in general, doesn't seem to have many answers to their mysteries. Some scientists, for example, seem to be in the dark about the side effects of medical cannabis, MS cures and how to speed up the research on both. What many patients already know is cannabis relieves pain, often with fewer side effects than conventional medicine.

adapted from an article by the Medicinal Marijuana Association

further information from The Medical Journal of Australia, Safe Access Now, Granny Storm Crows List 2015 and MS Australia