Cannabis use in MS is here to stay

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Muscle spasms, stiffness (also known in medical speak as spasticity) and pain are major problem areas in MS. Most are on tablets for this, commonly baclofen, with fewer individuals receiving botox for focal areas of stffness or intrathecal (via lumbar puncture directly into the CSF) baclofen for severe lower limb stiffness. Many also use cannabis for this indication, but the exact usage is unknown.

Since it’s legalization in the UK for medical use, several stores selling cannabis openly have popped up. Some of my patients have even tried it with initial success, or have been using it on and off.

This study is a survey of cannabis users with MS in Portland, Oregon (91 participants in total).

There was no one single preferred route of taking cannabis (see figure below), and 28 out of 33 current users found cannabis somewhat to very helpful for pain, whilst 26 found it somewhat to very helpful for spasticity.

Forty-nine reported to have used cannabis in the past. But, out of the 91 total participants, 39 used only prescribed oral medications, 24 used a combination, and 9 only used cannabis. The latter is very much in line with what I have seen in my experience. It also tells us that we have not found a suitable and effective treatment strategy for managing stiffness and muscle spasms in MS.

Figure: Patterns of cannabis use among 91 PwMS and spasticity

Abstract

Mult Scler Relat Disord. 2020 Feb 11;41:102009. doi: 10.1016/j.msard.2020.102009. [Epub ahead of print]

Cannabis use in people with multiple sclerosis and spasticity: A cross-sectional analysis.

Rice J, Hugos C, Hildebrand A, Cameron M.

BACKGROUND:

Growing evidence supports that cannabinoids relieve MS-related spasticity but little is known about cannabis use among people with MS (PwMS) and spasticity.

OBJECTIVE:

To characterize cannabis use among PwMS and spasticity.

METHODS:

As part of baseline data collection for a spasticity intervention trial in Oregon, PwMS and self-reported spasticity answered questions about cannabis use.

RESULTS:

54% reported ever using cannabis and 36% currently use. 79% use multiple routes of administration, 58% use at least daily. 79% find cannabis helpful for spasticity and 26% use cannabis and prescribed oral antispasticity medications.

CONCLUSIONS:

Many PwMS and spasticity use cannabis and report it helps their spasticity.

About the author

Neuro Doc Gnanapavan

9 comments

    • This is the sprasy, but if you don’t know you are getting it you are not getting enough, you can’t have effect without the side effect…it’s called biology as the same target does both things but in differnt parts of the brain

      • Not entirely true, we don’t know necessarily what in cannabis is acting on spasticity or pain for that matter, we just hypothesise that it is THC.

        We also don’t know if the effect it has persists beyond getting high. Much like psilocybin or ketamine and their effects on depression, they persist after the high has passed.

        That is why I ask, would be great if it worked by modifying sleep. Then one could have it in the evening and be straight(sober) the next day.

        • As we were the first to identify the mechanism how cannabis works on spasticity, we can say without doubt that it is CB1 receptor and THC-dependent. Remove the THC and the anti-spastic activity disappears. It does according to reports improve sleep and may pwMS do take it at night because of this (it also calms overactive bladder).

        • In humans we cannot prove the the contents, but in animals we can and have. THC and CB1 is the major effect. The original claims was that cannabis worked in europe and USA, historically US cannabis had low cannabidiol, so the inference it is THC. Sure other chemicals in cannabis will modifty the THC effect.

          The is a small window in obtaining benefit and not getting high…it is simple biology that the two are inter-linked based on where the cannabinoid receptors are expressed.

          There is a massive sleep literature from the trials, that support improvements in sleep.

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