Multiple Sclerosis (MS), is a rare neurodegenerative disease that occurs when the body's own immune system begins to attack and destroy the myelin sheathing that covers nerve cells. Over time, this can lead to a wide range of issues in both the central and periphery nervous systems. Today there are approximately 1 million Americans living with MS – a disease for which no cure is currently available.
Over the last half-century, cannabis has emerged as a common self-administered medication amongst MS suffers to treat and alleviate some of the symptoms of the disease. And, over the last two decades, the medical science community has been exploring these potential benefits to this unique group of patients for whom there are few other options.
What is MS?
Multiple Sclerosis is a potentially disabling disease of the brain and nervous system. The root cause of the disease is unknown, but the disease progresses as the immune system attacks the sheathing of the neurons, impairing communication between parts of the body. As the disease progresses, scar tissue builds up on the neurons and the disease becomes irreversible. Symptoms of the disease vary greatly between individuals suffering from it; however, the list of symptoms includes spasticity, chronic pain of extremities, acute paroxysmal phenomenon (seizures), tremors, emotional dysfunction, anorexia/weight loss, weakness, bladder dysfunction, difficulty in walking or balance, and memory loss. Although there is no cure for MS, there are treatments that can alleviate symptoms and reduce the occurrence of or speed recovery from attacks. Some patients can get into remission from the disease, which may last for weeks or even years, but it does tend to relapse.
About a third of all MS patients report that the symptom which most impacts their quality of life is pain.MS patients suffer from a rare type of pain known as central neuropathic pain – a condition for which there is little scientific consensus on the definition of, and no targeted treatments. Currently, central pain issues are usually treated with CNS medications such as antidepressants and antiepileptics, or with high doses of opioids. All three of these medications are not well tolerated, have multiple common adverse side effects, and can be highly addictive – thus increasing patients' mortality rates.
The mechanisms of the disease are still being understood, but it is thought that inflammation could play a major role in the progression of the disease. As an immune-related disease linked to inflammation, it would logically follow that the body's endocannabinoid system could play a major role in the development and progression of the disease, and may also provide a way to treat it. The endocannabinoid system is made up of receptors that cover many of the cells found throughout the body. There are two main types of receptors, the first are known as CB-1 receptors and are found primarily in the brain, and the second is the CB-2 receptors that are found throughout the peripheral nervous system, immune system, and many organs. CB-1 receptors are responsive to the cannabinoid THC found in the cannabis plant, which causes the psychoactive effects of the plant. The CB-1 receptors have also been shown to play a role in controlling specialty is recent studies. The CB-2 receptors react to cannabidiol, or CBD, and have been shown to help reduce inflammation and modulate the immune system. As such, patients with MS commonly self-medicate using cannabis to both relieve their symptoms and reduce their dependency on opioids or other pharmaceutical medications.
Cannabis in the treatment of MS.
In a 1997 study published in the Journal of European Neurology, a small group of MS patients was administered a survey, and 30-97% of them stated that marijuana helped them to relieve the symptoms of their disease. In fact, over 70% claimed that it helped with the pain, spasticity, and tremor; strongly suggesting that cannabis could play a significant role in relieving some of the symptoms of the disease while increasing the quality of life for its suffers.
Similar, self-administered surveys, were given to other groups of patients in Novia Scotia, in the UK, and in British Columbia with similar results. One such study was in Portland, Oregon in 2019 found that 31% of respondents reported using cannabis at least once per week, with 56% using it daily. All respondents reported that cannabis was somewhat or very helpful for pain, and 78% said that it improved stability when used in conjunction with their prescribed medications. In the largest such study to date, 3,606 MS patients in Denmark were given surveys to fill out about their condition. That study found similar results, with 21% of respondents saying they used cannabis in the past year. Most of them also said that it helped with pain (61%), specialty (52%), and reduced sleep disturbances (46%). In all of the studies, the authors stated that the cannabis use was well tolerated, did not interfere with prescribed medications, and had only mild and relatively brief adverse side effects (drowsiness, feeling subdued, and dizziness).
What these studies showed is that the society of MS sufferers is already using cannabis and that at least anecdotally, it is helping to treat their symptoms and restore some of their quality of life. Following the turn of the century, these claims and observations started to be investigated by the medical science community, and have shown some exciting results that may change the way the disease is treated in the future.
Cannabis trials for MS
One of the first clinical trials for the use of cannabis in the treatment of MS was in regards to urinary symptoms, which affects up to 90% of MS patients. In an open-label study published in the Journal of Multiple Sclerosis in 2004, full-spectrum cannabis extracts containing nearly equal ratios of THC and CBD were given to 15 patients for 8 weeks, then only THC for another 8 weeks. Urinary issues were tracked quantitatively over the study period, as well as other issues such as pain, spasticity, and sleep disturbances. The study found that daily episodes of incontinence, the volume of incontinence, and daytime and nighttime frequency of urination all decreased significantly with both treatments, without much difference between the two (THC+CBD, or THC alone). Again, pain, spasticity, and sleep disturbances were also greatly reduced.
Although that study was not placebo-controlled, another study published in the same edition of the Journal of Multiple Sclerosis was. In this double-blind, randomized, placebo-controlled study, three separate treatment centers recruited a total of 160 patients with MS to trial the prescription drug Sativex, which contains a 1:1 THC to CBD cannabinoid ratio. The study found that specialty was greatly reduced in the group receiving the Sativex compared with the placebo and that there were no significant adverse effects on cognition. The study concluded that cannabis could play a role in the simultaneous treatment of several symptoms of MS and that it could do so "without troublesome side effects." A similar study (double-blind, randomized, placebo-controlled) Published in 2005 in the Journal of Neurology confirmed the previous study's findings regarding spasticity, pain, and sleep disturbances, and went on to state that cannabis-based medicines are effective at relieving MS-related central neuropathic pain and are well tolerated by patients. A Meta-reviews of the literature completed in 2007 came to the same conclusions regarding cannabis-based medications' effect on central neuropathic pain, one of the hardest pains to treat. It stated that there was a "clinically relevant and statistically significant lowering of pain scores."
The Role of Cannabis in MS Treatment
All of the studies conducted thus far have found that cannabis is safe and well-tolerated by MS patients. While it does not relieve all the symptoms of the disease for all patients, it has enough of an effect on a significantly large subset of MS patients that it will most likely go on to play a major role in how this disease is managed in the future. In a recent paper published in last April's edition of the Journal of Neurology, the case for cannabis was laid out very clearly. The authors stated that based on their trials and those published previously, MS patients who use medical cannabis "experienced improved symptomology with good tolerability" and that they were able "to decrease or altogether discontinue opioids, stimulates, and benzodiazepines." Because cannabis-based medications can address a range of symptoms simultaneously, they are especially useful in the treatment of MS and can help to reduce the side effects of current treatment options while also reducing the dangers of dependency or over-dose related deaths and increasing patient's quality of life.
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