Have you ever come across the term multiple sclerosis?

Did you know cannabis can act as a therapy for multiple sclerosis?

This article will help you learn what multiple sclerosis is, the disease and symptoms, and how cannabis can act as an effective therapeutic if integrated safely into the treatment plan.

What is Multiple Sclerosis?

Multiple sclerosis (MS) is an autoimmune disorder that affects the central nervous system, including the brain, spinal cord, and nerves. The immune cells of the body attack the protective covering of nerve fibres (myelin sheaths), resulting in gradual physical and mental disability with time.¹ The common symptoms of MS include numbness or tingling, blurry vision, weakness, fatigue, pain, inflammation, stiff muscles affecting movement (spasticity), and lack of coordination leading to cognitive dysfunction.² 

MS is highly prevalent in North America, Europe, and Australia, and individuals assigned female at birth (AFAB) are generally more prone to acquiring the disease when compared to persons assigned male at birth (AMAB).² MS is usually diagnosed when an individual is in their early twenties up until 50 years of age. Possible causes of MS include slow-acting viruses such as Epstein-Barr Virus (EBV), genetic factors, deficiency of Vitamin D, and lifestyle choices such as smoking. MS does not have a fully identified cure yet and is managed by a combination of Disease-modifying Therapies (DMTs). To learn more about the existing DMTs, see Table 3 in Treatment of MS. 

Types of MS

Multiple sclerosis is of different types based on symptoms and severity of the disease. They are:

• Clinically isolated syndrome (CIS): It is the onset of neurologic symptoms, including lack of coordination and balance, trouble with speaking, walking, etc. It may or may not develop into MS
• Relapsing-remitting multiple sclerosis (RRMS): It is the most common form of MS, where the symptoms appear from time to time (relapses), followed by periods of recovery (remission)
• Secondary progressive multiple sclerosis (SPMS): It slowly kicks in after RRMS, where symptoms worsen over time but without remissions
• Primary progressive multiple sclerosis (PPMS): It is rare and occurs in about 10-15% of people, where the disability and symptoms worsen from the beginning 

Cannabis and components

The word ‘Cannabis’ refers to different parts of the plant Cannabis Sativa. It has been mainly used as a recreational drug worldwide. Other uses of cannabis include industrial use for fibre, seeds, oil, and medicinal use (medical cannabis) to alleviate symptoms of nausea, vomiting, pain, and muscle spasms. Whether cannabis is good or bad depends on us as consumers: how and why we use it, how often we use it, and it can vary from person to person. 

The cannabis plant contains a group of substances called cannabinoids, of which tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most studied. THC is the main component that makes you feel high when you consume cannabis, while CBD is not intoxicating. To learn more about cannabis and its components, visit Cannabis and Cannabinoids. 

How safe is medical cannabis?

Although it is illegal to use cannabis as a recreational drug, many countries have legalised the use of cannabis for medicinal purposes. The plant contains certain chemicals with therapeutic properties that help manage symptoms associated with many disorders. Dronabinol was the first FDA-approved drug for the treatment of nausea/anorexia in cancer/AIDS, respectively. Another drug Epidiolex, was later approved for the treatment of seizures associated with disorders such as Lennox-Gastaut syndrome, Dravet syndrome, and Tuberous Sclerosis Complex. 

Medical cannabis is given by various routes of administration, including smoking, vapour inhalation, topical creams, sprays, tablets, and edible oils or tinctures. It mainly helps in anxiety and chronic pain management, improving sleep and quality of life. People with MS experience difficulty with balance, walking, and coordination as a result of impairment in signal transmission between the brain and spinal cord. Pain, dizziness, loss of bladder control, and depression are also common. Cannabinoids contribute to recovery from pain and spasticity associated with MS while improving their well-being.³ Sativex is the FDA-approved drug for muscle spasticity in MS(in the form of a spray), and there is research backing the positive effects of Sativex on the affected population.^4,5 Though there is evidence of the positive impact of medical cannabis on MS, high dosage and excess use can lead to short-term and long-term adverse effects.

Risks and side effects

While cannabis can be used for the treatment of MS or other diseases when prescribed, there is always a risk associated with its use. The adverse effects can be either short-term or long-term.

Short-term effects

• Dizziness
• Dry mouth
• Red eyes
• Altered sense of time and space, euphoric
• Slower response times
• Hallucinations
• Confusion and impaired memory
• Reduced coordination

Long-term effects

• Bronchitis: Smoking cannabis over a longer period can lead to cough, thickened mucus, and wheezing
• Cognitive decline: Memory, attention span, and concentration are affected due to the extensive use of cannabis⁶
• Cardiovascular effects: It increases blood pressure upon use and, over time, can lead to heart disease and stroke
• Mental health: Anxiety and depression, leading to withdrawal from society, can also result from the overuse of cannabis
• Cannabis use disorder: Adolescents who use cannabis frequently tend to develop addiction and are not able to quit using cannabis
• Drug interactions: Cannabis can interact with existing medications in use, resulting in adverse reactions

Pregnant individuals (AFAB) and people with a background of mental health disorders are not advised to use cannabis as it can have severe consequences later in life. 

How to use cannabis safely for MS treatment

If you are thinking of using medical cannabis to help ease symptoms of MS for yourself or your loved one, you need to make sure to have an effective and safe approach. Here’s a simple guide to follow:

• Be informed of local regulations: Make yourself aware of the legal status of medical cannabis in your region and the guidelines on how to obtain a prescription
• Consult with your healthcare provider: The first point of contact should be your doctor, who can provide you with all the information on available data based on your symptoms and condition. They can walk you through the possible benefits and adverse effects of cannabis, depending on the medications you take
• Choose the right products and delivery method: Your doctor can help you decide the best drug with the ideal THC: CBD ratio, along with the desired route of administration, again depending on your symptoms
• Select the correct dosage: Always start with a low dosage to measure the effects and gradually increase under medical supervision
• Maintain a journal: Keep track of changes in symptoms with dosage and time, and schedule follow-ups with your healthcare provider to reassess treatment

FAQs

Is multiple sclerosis fatal? Is it contagious?

No, MS is not fatal, and you cannot die from it. It is not spread from an affected person; it has to do more with family history and lifestyle. 

Can MS be cured?

No, it does not have a cure yet, but it is managed by the use of drugs which can keep your symptoms under control and slow down the disease progression.

How is MS diagnosed?

There is no single test to determine MS, but neurological history and examination can help. Other tools, such as MRI scans and lumbar punctures, can help in diagnosing MS.

Is medical cannabis legal and safe?

Medical cannabis is legal in many countries, but you need to make sure by confirming the same with the guidelines. Although it is legal, safety depends on the use and dosage.

Will medical cannabis make me high?

Not necessarily; the THC and CBD components in cannabis are used in combination to treat symptoms. Generally, doctors prescribe lower THC amounts, which are responsible for the “high” effect.

How can I get medical cannabis?

Your healthcare provider will provide the prescription and other necessary forms to the licensed producer. The producer will contact you for payment via phone or online, and the product will then be delivered to your home.

Is medical cannabis covered by insurance?

It is important to check with your insurance providers for this, as some of the insurance policies may cover medical cannabis.

Summary

With an increasing number of people getting affected by MS worldwide every year, it is important to have better treatment options for managing the disease. With existing DMTs, incorporating medical cannabis as an aid in treating the symptoms has proved beneficial to the patients. However, monitoring the use of cannabis in such cases is extremely important, as extensive use over a period can cause adverse effects on health. It is time we move towards a more holistic approach in MS management, where the primary aim should be to improve the quality of life. This can be achieved by combining conventional medicines (DMTs) with physiotherapy, mindfulness, and diet changes. Cannabis integration can be used as supportive care for the treatment.