Do you smoke cannabis?

D

The findings from this study may interest some of our readers. Cannabis use in MS is licensed for spasticity management and to a lesser extent proven to be helpful with refractory neuropathic pain. Some also use cannabis to manage the psychological downsides of MS. Given it’s increasingly popularity since legalisation, the authors set out to determine whether discontinuing cannabis worsened MS symptoms. The study consists of scoring anxiety and depression before and after cannabis withdrawal (CW) or continuation (CC).

They study group consisted of 44 MS participants who had smoked cannabis for ~ 8 years. Symptoms of anxiety and depression were recorded using the Hospital Anxiety and Depression Scale (HADS).

Surprisingly, they found that the depression scores (HADS-D) declined in those in the CW intervention group, whilst remaining unchanged in the CC group (see Table below; p=0.048); this was despite an increase in insomnia in the CW group (p=0.030). The threshold for significant depression in HADS-D is 8 to give you an idea of what the scores mean. Anxiety (HADS-A), on the other hand was no different between the two groups.

Table

Although this is a relatively small study, the surprising outcome warrants further scrutiny. If true, chronic cannabis use should be monitored in users with MS.

Mult Scler. 2020 Jun 26;1352458520934070. doi: 10.1177/1352458520934070. Online ahead of print.

Abstract

Discontinuing Cannabis Improves Depression in People With Multiple Sclerosis: A Short Report

Anthony FeinsteinCecilia MezaCristiana StefanW Richard Staines

To assess whether symptoms of depression change when people with multiple sclerosis (pwMS) discontinue cannabis use, 40 cognitively impaired pwMS who smoked cannabis almost daily were randomly assigned to either a cannabis continuation (CC) or cannabis withdrawal (CW) group. Both groups were followed for 28 days. All participants completed the Hospital Anxiety and Depression Scale. At day 28 the 11-nor-9-carboxy-Δ9-tetrahydro-cannabinol (THCCOOH)/creatinine ratio in the CW group declined to zero (p = 0.0001), but remained unchanged in the CC group (p = 0.709). Depression scores in those pwMS who were using cannabis to manage their depression remained statistically unchanged in the CC group, but declined in the CW group (p = 0.006). Despite pwMS using cannabis to help their mood, depression improved significantly off the drug. Our finding provides a cautionary note in relation to cannabis use in pwMS, at least with respect to depression.

About the author

Neuro Doc Gnanapavan

3 comments

  • I’ve never quite got my head around the contradictory reports that smoking tobacco makes MS worse and smoking cannabis improves MS. Sativex takes a minuscule proportion of the active chemicals in cannabis and delivers them without the partially combusted hydrocarbons (smoking) which kill half of all smokers. Eating cannabis seemed a much safer option. It would be interesting to see if Sativex produces the same effect as that seen in this study – or maybe it’s already been done, but wasn’t published because it would be detrimental to sales.

    • Good point and it suggests that the influence of smoking in miniscule, however in the USA/North America the difference between smoking cannabis and smoking tobacco is that in the US they do not use tobacco, and the improvement of cannabis in MS is symptomatic (effect in minutes) compared to the influence on progression (effect in months).

      “Sativex takes a minuscule proportion of the active chemicals in cannabis and delivers them without the partially combusted hydrocarbons (smoking) which kill half of all smokers”. The active ingredient in cannabis is largely THC and sativex plant has a massive amount of THC…You are buying into the GW spin that it is the other ingredients in cannabis that are important. This allowed them to get (A) a patent position by patenting a cultivar (B) Meant you had to grow it compared to a simple synthesis and (C) being a plant it allowed for a fast track compared to a chemical in terms of drug development.

      “Eating cannabis seemed a much safer option”. It may be safer than smoking but it is useless for cannabis deliver and this is why people smoke it (A) there is massive first pass effect where the vast majority of the ingested THC is destoyed in the liver before it reaches the main circulation and the brain (B) It has a very distorted pharmakokinetics and so there is a slow onset of effects and then a long duration of action meaning it is hard to dose titrate and because people are very different this is important. This is why sativex is a spray, the idea is that it gets into the blood stream via the blood vessels under the tounge and avoids the first-pass metabolism.

      I would suspect a vape form would be doing the rounds.

      As for smoking the heating also converts the THC acids into THC.

      They wouldnt be doing a study supporting stopping their drug…however it should be easy to do many people stop sativex as it doesnt work

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