Multiple Sclerosis (MS) is a degenerative disease of the central nervous system (brain and spinal cord) where the body’s immune system degrades the protective covering around axons known as the myelin sheath.This affects the brain’s communication between other neurons, leading to various symptoms, depending on the location of the lesion in the brain and the severity of degeneration. MS is thought to affect over 900,000 people in the U.S. alone. For uninsured patients treatment can cost anywhere from $15,000 to $50,000 per year. Incidence rates among women tend to be higher than their male counterparts and, for unknown reasons, it is more prevalent in colder climates at certain latitudes around the world. There is no known cure for MS and currently available treatments are designed only to slow the progression of the disease. Since the symptoms and severity of the disease can vary from patient to patient, there isn’t an accepted treatment plan that works for all MS patients. Treatment of MS often involves a multitude of pharmacologic agents. Despite multimodal treatment approaches, some patients still cannot find relief. This highlights the demand for additional therapeutic agents such as Medical Cannabis (MC).
Just how effective is MC at treating MS? Research in MC is currently in preliminary stages. Some studies show promising results while others raise questions about its true effectiveness. With that said, MC has recently spiked in popularity as a treatment option for many neurological disorders with a considerable amount of success, but how consistent can MC be at providing greater benefit than the current medications and treatment for these diseases? It will take more time to answer that question in its entirety, but the potential is there. Just like other medications, MC is used to relieve the common symptoms of MS such as pain and spasticity. There is research that suggests MC can also affect the demyelination that occurs in the brain, but this has not been fully validated. The majority of the research focuses on how MC helps address the symptoms that follow degeneration. Early reviews, including a systematic review by the American Academy of Neurology provide evidence that MC is effective at relieving spasticity and pain in MS patients. Another review done at the DENT Neurologic Institute in NYS also found efficacy in the treatment of MS symptoms with MC. This retrospective chart review was conducted on patients diagnosed with MS who received MC for symptom management. The results showed improvements in pain (72% of patients), muscle spasticity (48% of patients), and sleep disturbance (40% of patients). However, even with all of this data, more research and testing needs to be done before it is known just how effective MC can be at treating a disease like MS.
How might MC improve symptoms and outcomes for patients with MS? There are over 144 different cannabinoids that have been identified within the cannabis plant. The two most prevalent cannabinoids in MC products are THC and CBD. THC (Δ9-tetrahydrocannabinol) inhibits pain receptors and affects one’s mental state by binding to two types of G-protein coupled receptors (GPCRs), cannabinoid types 1 and 2 (CB1 and CB2). CB1 receptors are predominant in the central nervous system (CNS), while CB2 receptors reside mainly in the peripheral inflammatory and immune pathways. Cannabidiol (CBD) exerts different pharmacodynamic effects, many of which remain unclear. CBD also exhibits effects on GPCRs including opioid receptors, CB1, CB2, and certain serotonin receptors (serotonin is a neurotransmitter that controls mood). CB1 and CB2 cannabinoid receptor stimulation could potentially provide anti-inflammatory and neuroprotective functions. One should also note that there are endocannabinoids (naturally produced cannabinoids found within the human body). Evidence has shown that this natural endocannabinoid system can control the level of neurodegeneration that occurs as a result of inflammation. It is also theorized that a low level of endocannabinoids in the body may play a role in the development of MS. Therefore, supplementing cannabinoids through MC may not only offer symptom control, but could also slow the neurodegenerative progression of MS. That being said research into this subject is ongoing.
Opioid use is also common with patients experiencing pain and spasticity related to MS. Given that this class of medication comes with numerous side effects and risk of addiction, it is desirable for most patients to keep use to a minimum. MC may be an effective substitute that can provide similar if not more relief to MS symptoms than opioid drugs. The same retrospective study conducted at the DENT found that over half of patients using opioid medications for MS related pain were able to discontinue or decrease these medications after starting MC therapy.
The successful treatment of MS symptoms with MC is highly individualized. This is not only because of the unpredictability of MS symptoms, but also because of the fluctuating chemical composition of individual MC products. With more than 144 cannabinoids present within the plant, each MC product contains varying quantities of cannabinoids and other phytochemicals. This means the ratios of the different cannabinoids including THC and CBD, and other chemicals, may fluctuate depending on the product utilized which can lead to differing outcomes and symptom control between patients. The optimal THC/CBD ratio, dosing, and route of administration are not yet abundantly clear. Given this large degree of variability more research is needed to understand how each individual cannabinoid impacts MS symptomology or any other neurological condition for that matter.
Overall, there is evidence showing promising efficacy in treating MS symptoms with MC. Despite this, issues of legality limit widespread access to this treatment in the US. Currently, there are no MC products that are approved by the Food and Drug Administration (FDA) to treat MS symptoms. More studies on the safety, efficacy, and optimal dosing need to be done in order to influence future legislation as it pertains to the legalization of MC in the US.