Last year should probably be marked as the year of the alcohol, the year before that, Vape stores and Cannabis extracts. I remember being offered ‘Leef’ based skin care products at the airport even. Not surprisingly, given the current climes, there is even talk that COVID19 may have provided the impetus for legalization of cannabis as part of a campaign to plug the current 2tn hole in the UK public finances.
CBD oil on the other hand is legal as long as there is no more than 0.2% THC, or tetrahydrocannabinol (contributes to the psychoactive effect of cannabis) in the UK. Anecdotally, it is supposed to help with pain and spasticity. I have received feedback from a number of my MS patients who have tried it and found it wanting; majority agreeing that effects don’t last beyond the month or the side effects limit it’s use.
This study from Denmark looks at cannabis oil taken at night time in a small group of MS patients over a period of 4 weeks, noting any side effects and any beneficial effects along the way. The cannabis oil (THC DROPS (25 mg THC, <2 mg CBD/ mL), CBD DROPS (25 mg CBD, 2 mg THC/mL) and 1:1 DROPS (12.5 mg THC and CBD/mL) was used as an add-on therapy to existing symptomatic MS medications.
The most frequent side effects noted were dry mouth, drowsiness, dizziness and nausea, related to oils containing THC levels >2 mg/ml (see Table 1 below for more detail). There were, however, improvements in perceived pain, spasticity and sleep disturbance in THC containing formulations (see Table 2 below), so maybe a closer study is warranted.
Safety and efficacy of low-dose medical cannabis oils in multiple sclerosis
Introduction: The use of cannabis as medical therapy to treat chronic pain and spasticity in patients with multiple sclerosis (MS) is increasing. However, the evidence on safety when initiating treatment with medical cannabis oils is limited. The aim of this study was to investigate the safety of sublingual medical cannabis oils in patients with MS.
Methods: In this prospective observational safety study 28 patients with MS were treated with medical cannabis oils (THC-rich, CBD-rich and THC+CBD combined products) and were followed during a titration period of four weeks. Patients were evaluated at treatment start (Visit 1) and after four weeks treatment (Visit 2). At each visit neurological examination (Expanded Disability Status Scale – EDSS), ambulation (Timed 25-Foot Walk Test – T25FWT), routine blood tests, plasma cannabinoids, dexterity (9-Hole Peg Test – 9-HPT) and processing speed (Symbol Digit Modalities Test – SDMT) were tested. Adverse events (AEs) and tolerability were reported at Visit 2. Secondary, efficacy of medical cannabis on pain, spasticity and sleep disturbances were measured by numeric rating scale (NRS-11) each day during the 4-week treatment period.
Results: During treatment with cannabis preparations containing 10-25 mg/mL THC, the most common AEs were dry mouth, drowsiness, dizziness and nausea of mild to moderate degree. Two patients experienced pronounced symptoms with excessive dreaming and drowsiness, respectively, which led to treatment stop during the titration. Three serious adverse events (SAE) were reported but were not associated with the treatment. Mean doses of THC and CBD were 4.0 mg and 7.0 mg, respectively, and primarily administered as a once-daily evening dose. Furthermore, pain decreased from a median NRS score of 7 to 4, (p = 0.01), spasticity decreased from a median NRS score of 6 to 2.5 (p = 0.01) and sleep disturbances decreased from a median NRS score of 7 to 3 (p < 0.001). No impairment in disability, ambulation, dexterity or processing speed was observed.
Conclusion: Treatment with medical cannabis oils was safe and well tolerated, and resulted in a reduction in pain intensity, spasticity and sleep disturbances in MS patients. This suggests that medical cannabis oils can be used safely, especially at relatively low doses and with slow titration, as an alternative to treat MS-related symptoms when conventional therapy is inadequate.