This is not a drug, a leaf

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Introduction to the Basics of Cannabis

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.

Table 1: Side effects
Table 2: Beneficial effects (P<0.05 is statistically significant)

Abstract

Safety and efficacy of low-dose medical cannabis oils in multiple sclerosis

Gustavsen S Søndergaard HbLinnet K Thomsen R Rasmussen Bs Sorensen Ps Sellebjerg F Oturai Ab

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.

About the author

Neuro Doc Gnanapavan

14 comments

  • I find these ongoing cannabis studies beyond annoying and utterly frustrating. GW Pharma has been at the forefront of cannabis based oromucosal spray for MS associated spasticity for years. They have exhaustive data on the efficacy and safety of THC and CBD. To all the future researchers, please stop the repetitive studies. It’s been done. I realize that there are many compounds beyond THC and CBD in C. sativa. But if you don’t have any new info then stop. BTW I have no vested interest in GW Pharma.

    • Nice one…but deaf ears await you. It has been a frustrating experience working in the space of stoners and potdocs…We showed year about 20years ago that THC is the active ingredient for a number of these effects and they are mediated by CB1, CBD is not the answer. We showed it is not immunosupressive unless you use crazy doses….twenty years on and the literature is full of papers about the immunosuppressive effects of cannabis, so many that this is the current view :-(.
      CBD is not inert but…as you say it is endless.

  • I look forward to the day when pure cbd oil is available on the amazing NHS.
    It’s the added ingredients that cause the problems – Sativex has totally unnecessary ingredients for example and the flavourings would be what makes me ill. Pure cbd oil tastes fine. Oh I look forward to that day – it will help millions of people – not just in ms but in many ailments………

    • Pure CBD is a solid that I get from the chemical shop and so what is in the oil so is the oil an added ingredient. As for sativex it is a medicine and not a sweet, the plant products are dissolved in alcohol or it that creme de Menthe.

      Make it available..but for what…NHS medicines are supposed to be evidence based please point us to the scientific evidence

        • I don’t know a hundred bad trials are still a hundred bad trials…I used to go to a cannabis meeting and when sat talking to one of the particupants saying it does this and that and when you ask how do you know the answer comes I have used it on myself…

          • I understand your skepticism. It’s just when MS hit Me and my body is deteriorating and pain keeps me awake and opioids and ethanol will only kill me, I would not suggest You try it. I would ask you to believe me when I say it helps my pain and mood. Some strains work better. Anecdotally I believe it displaces the “yuk”, metabolites and other inflammatory remnants grating at my nerves. I know that sounds flaky. Thanks for listening.

          • I am not skeptical and fully accept that cannabinoids can do things but the importance is that these effects are shown and this is when it all falls apart as the anecdote fails to convince

        • Beyond an additional study to the Sativex study looking at efficacy of cannabis in pain in MS, there are very few controlled studies. This evidence base is needed. The above study though weak in sample size and duration can form the basis for a future study and will add to the evidence base.

  • Slept very poorly last night. A few hours, then excruciating pain in my thumb, brain started racing. CBD flower/vapor is all I can get in Virginia. Low THC Medical cannabis oil is legal now. With a license that cost me to hire a Doctor through Veriheal because my University Doctors aren’t ready to certify Me. It is both Unavailable except in a few dispensaries far from me, the price prohibitively expensive. Listen to your patients. I have tried to tell lawmakers and FDA. Virginia reported plans to step up legalization but not too soon. Our Doctor Governor doesn’t want it legal until he leaves office. My experience: https://traveloguefortheuniverse.blogspot.com/search?q=Cannabis+ BTW it’s Legal in Washington DC where federal lawmakers can use all they want Non medical too.

  • I began taking CBD capsules (with very low-dose THC) for spasticity under supervision of a doctor with specialized training in cannabis therapy. My neurologist had no objection, saying many of her patients reported significant sustained benefit from various types of cannabis. However, I discontinued the capsules after only a week after my psychiatrist strongly advised against the use of cannabis (CBD or THC) in any form by people with MS. His concern was the risk of long-term decline in cognition, which he said was substantial and demonstrated in high-quality studies. I haven’t had the chance to research this myself but pass it on to indicate that for some practitioners, efficacy and tolerability are apparently not the only concerns.

    • I’m afraid many psychiatrists are still adherents of the “reefer madness” persuasion. It’s not helpful and much, much more nuanced than he is suggesting, particularly where the THC content may be negligible.

    • Can you get your psychiatrist to provide some evidence? I know of some small studies assessing PwMS who smoke marijuana regularly vs PwMS who do not smoke showing functional MRI differences and other showing impacts on cognitive function. Also that this improved when people stopped smoking. However this was not low-THC and would have been interesting to assess the effects in those without MS to see if it is was just weed related.

      As far as I am aware, low THC CBD has no impact on cognition.

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