Introduction

Multiple Sclerosis (MS) is a chronic autoimmune disease that attacks the myelin sheath of neurons, causing neuronal dysfunction and a progressive loss of movement capabilities.

First occurrence and acute relapses present during early adulthood, with permanent disability occurring 10-15 years after diagnosis.¹

Multiple Sclerosis

Symptoms

Symptoms are plentiful and vary, depending on the location of the lesion caused by immune responses:

• Vision impairment
• Numbness and tingling
• Motor weakness, poor coordination, and balance
• Focal weakness
• Bladder and bowel dysfunction
• Cognitive impairment – Memory impairment, executive dysfunction, difficulty focusing
• Depression and Anxiety

Symptoms in MS often relapse, getting better for a period before worsening. This can last as short as a day, but last for even weeks when first occurring.

• 15-20% of MS patients don’t experience relapsing or remitting, and symptoms simply deteriorate over time. In 5% of patients, they experience both gradual deterioration and superimposed relapse.

Patients who only experience relapses often recover but can be left with lasting damage or buildup of issues that can lead to disability later in life.

Current treatments

Immediate treatment plans are necessary for treating symptoms and relapses in MS. Drugs used to assist in cellular function and inhibit immune cell functionality to assist in minimising consequences.

Treatment also attempts to address the neurological symptoms affected and what caused a relapse. Aftercare of a relapse is extremely important in preventing disability.

Specialised treatment for the symptoms is personalised and dependent on the individual and their specific circumstances

Cannabis

Cannabis is a well-known drug. It is typically a grown plant that can be crushed up and either taken through smoke inhalation or digested. This gives the individual a high, often producing an elated low anxiety feeling. It does so by targeting certain receptors in the brain that produce an extremely reduced opioid effect.²

Recreation and Medication

Cannabis has become much more popularly used as a self-medicating drug. While it is also used to attain a high, many people are using it to assist in anxieties and chronic pain. While not FDA approved, many people report an improvement in symptoms with or without a high and others have indicated towards its potential therapeutic benefit, including on a governmental level.²

Kinds of cannabis

The type of cannabis can indicate the possible benefits. THC (Δ9-tetrahydrocannabinol) is the most widely studied form due to its significant psychoactive effects, present in the flower buds and leaves. CBD (cannabinol), CBC (cannabichromene) and CBG (cannabigerol) are present in the flower buds and leaves too, but are not psychoactive.

• THC has anti-inflammatory and psychoactive effects
• CBD has anti-inflammatory and anxiolytic properties and isn’t psychoactive

Cannabinoids activate CB1 and CB2 to modulate the effects of certain systems present in hunger, mood, memory, pain, and neurogenesis. It does so through altering the release of neurotransmitters like dopamine, acetylcholine, GABA, serotonin, opioids, etc.²

Legalisation and use as a therapeutic

In many places, cannabis use is still classed as a crime, including for medicinal purposes. This prevents proper therapies from being explored and incriminates those who haven’t found an effective option for their ailments, regardless of the personal effectiveness.

Cannabis has shown promising results to be an effective treatment for a wide array of conditions, from anxiety to cancer to bone loss, with many more possibilities. However, due to the nature of the drug, it is rarely used medicinally and does not receive enough attention to convince governmental bodies that it has potential for public health use.²

Therapeutic effects of cannabis in MS

As mentioned, cannabis has many possible therapeutic effects, and this is also true for MS. 1 in 5 MS patients use cannabis to help mediate their symptoms (UK patients in 2014).

The wide array of effects that cannabis can modulate can match many of the symptoms that MS causes in day-to-day life:^3,4

Anti-inflammatory

Cannabis is an anti-inflammatory drug, and a pathology of multiple sclerosis is the increased inflammation due to the immune response. A decrease in inflammation decreases the damage towards healthy neurons and reduces the symptoms at the point of relapse.

Pain management

Cannabis can be used in chronic pain management due to the release of opioids and inhibition of pain receptors in the central nervous system. MS patients can experience high levels of pain during relapse, and damage from lesions can result in chronic pain.

Movement

Cannabis has been used to help with:

• Spasticity
  • This is the most prevalent and concerning symptom, having major consequences for the disease and quality of life. Use of cannabinoids with other therapies can have high efficacy for treating spasticity
• Walking
• Fatigue
• Poor balance and coordination
• These effects have been seen in neurodegenerative diseases like ALS. However, in MS, some cannabinoids have had conflicting results on their efficacy in movement. More research is required to confirm how efficacious the effects are in either direction^{3, 4}

Sleep Issues

MS patients have reported that a lack of sleep can exacerbate MS symptoms. MS sleep disturbances are a very common symptom in MS patients and are a source of discomfort and risk of other conditions, as well as worsening their own.

Cannabis can be used to help those with issues sleeping and promote good rest, helping MS-exacerbated symptoms and maintaining better health. Studies have not reached a certain conclusion, but cannabis is still widely used for this purpose.^3,4

Bowel Issues

Bladder and bowel issues are prevalent symptoms in MS, often having overactive symptoms. Urinary urgency and incontinence are sources of discomfort and reduced quality, even causing immobility. Cannabis is found to have a positive effect on this in some cases.^3,4

Mental Health

Cannabis, due to its effects as a high-inducing anxiolytic drug, has been known to temporarily assist in an individual's mental health, elevating mood within bouts of depression. However, not seeking other, more permanent solutions will result in reliance on cannabis and other side effects like increased tolerance and addiction.²

MS patients have reported using cannabis for a variety of their symptoms; however, there may not be enough evidence that it is having a significant effect.

Unfortunately, for many of these symptoms and even disease progression, the supporting evidence is lacking in conclusions and requires further observations.²

Risks and Considerations

Cannabis, while having positive effects, does have serious side effects and considerations.

Side effects

The side effects of using cannabis in therapeutics for MS have ranged from ‘mild’ to ‘moderate’ depending on dose, frequency, method of consumption, type of cannabinoids, etc.

Reported adverse effects include:²

• Gastrointestinal issues – nausea, vomiting, diarrhoea
• Urinary tract infections, too
• Dry mouth
• Dizziness/light-headedness – Headaches are also common
• Cognitive symptoms such as attention disturbance and disorientation
• Fatigue
• Despair

Cannabis has been reported to cause further risks of developing problems with:^2,4

• Cognitive processes such as memory and thinking
• Emotional processes
• Breathing & Bronchitis
• Diabetes
• Lung diseases
• Heart attack risk
• Stroke

Tolerance & Dependence

Because cannabis has effects in the brain and the associated receptors that are affected, tolerance to cannabis can increase over time, making it harder to receive any of the positive effects from a recreational and medicinal standpoint. High doses of cannabis can frequently cause an overproduction of the affected processes to compensate, meaning that there is now more to overcome to reach the desired state.⁵ 

This has huge implications for addiction and dependence. For the most part, cannabis is not highly addictive like other drugs it is often compared to, like cocaine and heroin. It can still be addictive, though, much like any substance can be addictive. The build-up of tolerance and the effect that cannabis has on the reward pathway can lead to needing more to feel the high and other desired effects. Taking more and more in this manner can lead to partaking in higher doses just to remove the ill effects, leading to addiction and dependence.⁵

Reactions with other medications

Cannabis may also react badly with other medications being prescribed, heightening/inhibiting the effects desired. When medicating with cannabis, talk with a neurologist and psychiatrist to understand what doses, types, and MS medications should be taken to minimise interactions and attain the best outcomes.²

Individual dosing and management are highly important in this regard, and not exceeding recommended values is important. Integration of other therapies is also important, such as exercise and diet, to help manage symptoms and improve health to mitigate immune responses.²

The benefits of cannabis in MS patients are limited and widely vary, the likely benefits not outweighing the common side effects and potential risks. However, studies don’t determine that side effects should limit clinical use for MS.²

Summary

Cannabis is said to have many beneficial properties in mitigating common MS symptoms, ranging from benefits in pain management, sleep issues, mental health and more. Many MS patients self-medicate with cannabis.

There are many concerns related to the use of cannabis, such as cognitive issues, tolerance and addiction and increased risk of certain events such as lung diseases.

Cannabis is still illegal in many places, but the use of medicinal cannabis is becoming more and more widespread. However, the benefit-to-risk ratio is of concern, and whether it is an adequate form of medication. Unfortunately, the literature seems conflicting in the benefits, risks, and whether it is an efficacious therapy.

Implementation into MS treatment should be carefully considered and discussed with your healthcare professionals. Risks of tolerance, interactions with other medications, and the benefits are all very personal and will depend on a variety of factors. A personalised care plan with a mix of medications and physical and mental therapies is the best strategy to abate MS symptoms.