Multiple Sclerosis

Multiple Sclerosis (MS) is the most common autoimmune inflammatory disease, affecting 1 of every 1,000 persons worldwide. The immune system attacks the myelin protective covering of neurons in the brain and spinal cord, thus interfering with the ability of nerves to function properly. Symptoms include numbness and/or weakness of limbs, vision problems, body tingling or pain, fatigue, tremor, unsteady gait, bowel or bladder problems and muscle spasticity. Symptoms can progress over time or can come as episodes called attacks or flare-ups. There is no known cure for MS. Treatment is aimed at preventing attacks and at treating symptoms to maintain quality of life. Patients struggle with compliance with MS medications as they have many adverse side effects.

Numerous studies have examined the use of cannabinoids to treat MS. Much of the research comes from investigations on the efficacy of Sativex (GW Pharmaceuticals), a sublingual preparation of CBD and THC in a 1:1 ratio, which is the only cannabis-based medication currently approved in 27 countries (not the U.S.) for treatment of MS spasticity. Sativex has been shown to be effective for spasticity, intractable peripheral neuropathy and MS-induced pain.

Here is a summary of some of the research of cannabis use for MS:

• In 1981, neurologists evaluated nine patients with MS who reported significant spasticity before and after using inhaled cannabis. In the double-blinded study, the blinded examiner evaluated muscle tone, reflexes, strength and EMG results both pre-and post-treatment with THC and was able to correctly identify which patients received THC in 78% of cases.¹
• In 2001, an open-label pilot study of cannabis-based medicinal extract showed improved lower urinary tract dysfunction in 10 out of 10 patients with advanced MS refractory urinary tract dysfunction over eight weeks of treatment.²
• In 2003, investigators found cannabis to have statistically significant benefits versus a placebo for MS patients with urge incontinence.³
• In 2006, an extended open-label study of 167 MS patients found that whole plant cannabinoid extracts relieved pain, spasticity and bladder incontinence for a mean of 434 days without an increase in dose.⁴
• In 2007, another extended two year, open-label extension trial reported that whole plant cannabis extracts was associated with long-term reduction of pain in select MS patients, with fewer daily doses and lower median pain scores the longer they were on the medication.⁵
• In 2010, investigators at the University of California at San Diego reported that inhaled cannabis significantly reduced objective measures of pain intensity and spasticity in patients with MS in a placebo-controlled, randomized clinical trial. Investigators concluded that “smoked cannabis was superior to placebo in reducing spasticity and pain in patients with multiple sclerosis and provided some benefit beyond currently prescribed treatment.”⁶
• In 2014, Spanish researchers treated 50 MS patients with inhaled CBD+THC for spasticity and pain, and found it to be 80% effective.⁷
• In 2015, in a mice model of MS, Sativex improved motor activity, reduced brain cell damage and CBD was found to alleviate motor deterioration.⁸

A survey in 2002 reported that almost 50% of MS patients use cannabis medically.⁹ Another survey in 2006 reported that those with increased disability were more likely to use cannabis.¹⁰

I have seen many patients with MS that report that cannabis use reduces pain, lessens spasticity, alleviates depression, lessens fatigue and decreases incontinence. They report that cannabis acts as a potent and quick-acting muscle relaxant. As mentioned in previous chapters, cannabinoids serve a neuroprotective function and may inhibit the progression of disease, as well as boost immune function in MS patients. Most of my MS patients prefer using vaporizers or sublingual tinctures as these methods have quick onset and are easy to dose. Patients report using THC-rich, CBD-rich and combination CBD+THC cannabis based on their personal preference and response. Some experts recommend blending different chemovars as this enhances the cannabinoid content and terpenoid profile, which may improve effectiveness.