Cannabis and Multiple Sclerosis (MS)
Multiple Sclerosis (MS) is an autoimmune disorder characterized by chronic inflammation and nerve cell degeneration—specifically demyelination, a process that strips the protective sheath surrounding nerve cells—which affects millions of people worldwide. For many, symptoms such as pain and muscle tightness can be debilitating, or even unbearable for some—about half of all MS patients suffer from depression, and they are twice as likely to commit suicide. Common symptoms include pain, muscle spasticity and spasms, sleep disturbances, tremors, bladder issues, anxiety and depression, balance issues, and cognitive impairment. For the last couple of decades, however, as many as two thirds of all people suffering from MS have found significant symptom relief by using medical marijuana.
It’s not really a surprise that cannabis offers relief for those with MS. Several cannabinoids have been found to have strong anti-inflammatory and neuroprotective effects, characteristics that directly relate to the cause of the disease. Inflammation plays a key role in pain and fatigue experienced by individuals with MS, so treating the disease with an anti-inflammatory seems like a no-brainer. There is also significant evidence that THC and CBD can reduce muscle spasticity and spasms, another major contributor to the pain patients experience. Pain and spasticity can also cause sleep problems in those suffering with MS, another symptom cannabis is known to help with. In fact, a study done on 96 patients by researchers at the Rocky Mountain MS Center at the University of Colorado found that 32% use CBD and 52% use THC for pain, 21% use CBD and 32% use THC for sleep, and 42% use CBD and 23% use THC for muscle tightness. Cannabis not only reduces the severity of these symptoms, it reduces the amount of other medications, like opiates or benzodiazepines, that are commonly prescribed and have long lists of negative side effects. Additionally, there is evidence to support that cannabis can also work to improve the anxiety and depression many patients suffer.
Other symptoms, like tremor and incontinence, seem to be largely unaffected by cannabis use—neither helped nor harmed. There is also some concern that THC might have some negative psychiatric side effects, but most researchers are quick to point out that CBD counteracts many of these side effects and therefore CBD or CBD dominant medications potentially pose less of a risk. And while concern of negative psychiatric side effects is by no means limited to the use cannabis in treating MS—you could probably even argue it’s a concern regarding the use of cannabis just in general—but it might be more relevant due to the predisposition of MS patients to cognitive dysfunction and psychiatric disorders like anxiety and depression. (One researcher even told Neurology Advisor in an interview that he observed worsening cognitive impairment, particularly in older patients.) It’s also important to note that many of the cells affected or involved—mostly CB1 receptors in the central nervous system (CNS)—have cannabinoid receptors.
While we know definitively that cannabis is effective at treating the major symptoms of MS, there is almost no research on how cannabis effects the root of the disease. The National MS Society’s official position on the use of cannabis to treat MS symptoms ‘supports the ability of people living with MS to make informed choices about their treatments with their MS healthcare providers, including the use of medical cannabis’ and they are ‘evaluating ways [they] can remove the barriers to allowing research.’ One can speculate that the neuroprotective and neurogenerative qualities of multiple cannabinoids may be able to slow-down, stop, or even reverse the demyelination process, but at this point it is still only speculation. Animal studies have reported immunomodulatory and neuroprotective effects, but nowhere near enough human trials have been done. Barriers to research are preventing patients from receiving beneficial treatments.
Stigma and lack of information prevent many patients from even asking about cannabis, and the prohibitive government restrictions preventing earnest scientific consideration only reinforce these sentiments. All in all, the biggest danger to MS patients regarding cannabis seems to be the lack of availability. Sure, it’s possible that research would show that cannabis is harmful in the long-term, or that it has negative drug interactions which poses risk to at least some patients. But so far the majority of the evidence points to the contrary.