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Medical Cannabis for Managing Multiple Sclerosis (MS)

Total Studies on Topic

Out of 5,337 studies (all conditions) in the Leafwell database:

182 total studies on cannabis and cannabinoids for managing MS

162 positive results

13 inconclusive results

7 negative results

Summary

There are many studies on the use of medical cannabis for managing multiple sclerosis (MS). In the Leafwell database alone, there are 182, with 89% of them yielding positive results. 31 of these are human trials (12 double-blind), with 88% of them being positive.

There is also a cannabis-based medication called “Sativex” (nabiximols), which is available under prescription in the U.K. and 28 other countries for managing spasms and chronic pain associated with MS. Medical cannabis could also help manage immune system dysregulation and neuroinflammation (inflammation of the nervous system) associated with MS.

a patient listening to his doctor's explanation outside the MRI machine

Pros

  • Tetrahydrocannabinol (THC) could help reduce muscle spasms and stiffness associated with MS. [1]
  • There is some limited evidence that medical cannabis could help manage bladder dysfunction associated with MS. [2]
  • Medical cannabis can help manage neuropathic (nerve) pain [3] associated with MS (although it should be noted that some positive studies suffer from bias).
  • It may prevent swelling of the brain and optic nerve [4] — many cannabinoids, including THC and cannabidiol (CBD), may contribute to this effect.
  • CBD may be neuroprotective and may even counteract MS development. [5] This could be due to its ability to prevent inflammation in the brain. [6]
  • Medical cannabis helps manage the side effects of other medications used for MS (e.g., fingolimod, teriflunomide, antidepressants, gabapentin), including nausea, fatigue, dependence, and weight problems.
  • Compounds in cannabis (e.g., CBD, CBG) may promote neurogenesis (the growth of new brain cells).
  • For those undergoing chemotherapy for their MS, medical cannabis can help manage chemotherapy-induced pain, nausea, insomnia, appetite loss, and anxiety. Chemotherapy drugs used to treat MS include azathioprine, cyclophosphamide, methotrexate, and mitoxantrone.

Cons

  • Too much THC may cause confusion and other adverse effects. 1:1 THC:CBD ratios are often considered most therapeutic for MS as the side effects of THC are “cushioned” by CBD to some extent.
  • The user’s age also matters: Younger MS sufferers under 25 may need to be careful using too much THC, as it may have negative effects on memory. [7]
  • The side effects of psychoactive cannabinoids like THC may be overwhelming for some, especially if they are new to cannabis. Dizziness, drowsiness, and disorientation are common side effects. Tolerance will need to be built.
  • Not all forms of MS are cannabinoid-responsive.

Recommended Strains

Different people react differently to different strains (cultivars), so picking any one particular strain or group of strains can be difficult. What works for one person may not work for another. However, as many studies on utilizing cannabis with 1:1 THC:CBD ratios yield positive results, it may be worthwhile exploring strains like:

  • Harlequin
  • ACDC
  • Critical Mass CBD
  • Sour Tsunami
  • CBD Hash Plant
  • CBD Mango Haze

Some patients have reported positive experiences with some THC- and CBD-rich cannabis varieties as well. Examples include:

  • OG Shark
  • Pink Kush
  • Master Kush
  • Jack Herer
  • Warlock
  • Skywalker
  • Charlotte’s Web
  • Ringo’s Gift
  • Remedy

Could Medical Cannabis Help?

There is a strong body of evidence to suggest that cannabis and cannabinoids like THC and CBD could help manage spasms, neuropathic pain, and bladder control issues associated with MS. Other cannabinoids, like cannabigerol (CBG) and cannabichromene (CBC), could be useful for their neurogenic, neuroprotective, and anxiolytic (anti-anxiety) effects, [8] which could help manage many diseases associated with the brain and nervous system. Furthermore, the immunomodulatory effects of cannabinoids could help reduce inflammation associated with immune-mediated versions of MS. [9]

What Is Multiple Sclerosis (MS)?

MS is a demyelinating disease where the myelin sheath that protects nerve cells is damaged. This impairs the conduction of signals across nerve cells and, over time, can cause persistent muscle spasms and consistent nerve pain (neuropathy). Approximately 2.8 million people [10] worldwide suffer from MS, with around 400,000 sufferers in the U.S. [11] MS is more prevalent further away from the equator, and most diagnosed sufferers are from the U.S. or Europe. MS is more prevalent in women than in men. [12]

Symptoms include fatigue, numbness, tingling, muscle spasms, mobility problems, confusion and problems with thinking and planning, depression and anxiety, bladder dysfunction, and nerve and muscle pain. Symptoms can progressively build over time in those with MS and can lead to vision problems and blindness as well. In some cases, MS occurs in recurring, isolated attacks.

Chronic inflammation and immune system dysregulation are common characteristics of MS. [13]

In some forms of MS, the body’s immune system attacks the body’s nervous system, and T-regulatory cells do not function properly. T-cells become activated in the lymph system and enter the central nervous system, causing inflammation and damage. T-cells activate helper B-cells, which activate antibodies and cause further damage to the CNS and myelin sheath surrounding nerves.

This form of MS is considered an autoimmune or autoimmune-like disorder, but not all forms of MS follow this diagnostic pattern. Some propose that MS is not an autoimmune disease at all. [14] It may be more accurate to call MS an “immune-mediated” [15] condition instead of an autoimmune disease or disorder, but this is still debated.

Why Might Medical Cannabis Help Manage MS?

Medical cannabis may help manage MS as it:

  • THC and CBD reduce the number of inflammatory proteins produced by the body, which, in turn, suppresses muscle spasm response. [16]
  • THC and CBD can reduce fatigue, insomnia, chronic pain (in particular neuropathic pain), anxiety, and depression in those with MS.
  • THC and CBD may help alleviate an overactive bladder, [17] which is common in those with MS.
  • Cannabinoids and terpenes like THC, CBD, CBG, CBC, beta-caryophyllene, and pinene may help promote neurogenesis and help rebuild the brain, ultimately slowing down neurodegeneration. [18]

Any Potential Negatives?

As with any medicine, cannabis must be dosed appropriately and according to the person’s condition and physiology. Taking too much cannabis, especially THC-rich cannabis, may:

  • Have negative impacts on memory.
  • Reduce balance.
  • Cause nausea or vomiting.

What Is Sativex?

Sativex (nabiximols) is a prescription medication that uses a mixture of THC and CBD to treat MS. [19] Sativex may also be of use for any neuropathic pain associated with MS. [20] Sativex was produced by GW Pharmaceuticals (now a part of Jazz Pharmaceuticals) and has an approximate THC:CBD ratio of 1:1. This means that there is already a significant body of evidence showing that medical cannabis and marijuana extracts can be effective for MS.

Sativex or nabiximols is not available on prescription in the U.S., although it is being investigated for potential approval in the future. [21] Sativex is currently in Phase II trials.

GW Pharmaceuticals was also responsible for developing the epilepsy medication, Epidiolex.

Will THC or CBD Alone Help Manage MS?

There is little research on whether CBD-rich or CBD-only products can help manage the symptoms of MS. CBD supplementation may help reduce pain, inflammation, fatigue, depression, and spasticity in those with MS, thereby improving mobility in those with MS. [22]

THC has pain-relieving, anti-inflammatory, and antispasmodic properties that synergize with CBD and help improve its therapeutic effects. THC-rich or THC-only products may also have these properties, but some could find the effects of THC overwhelming. CBD could help balance out some of the negatives of THC while boosting its therapeutic properties via the entourage effect.

What About the Terpenes in Cannabis? Could They Help Manage MS?

Several terpenes in cannabis could help manage MS, including:

  • Myrcene for its sedative effects.
  • Beta-caryophyllene for its anti-inflammatory effects, as well as its possible remyelinating effects. [23]
  • Limonene for its mood-enhancing effects.
  • Linalool for its relaxing effects.
  • Pinene for its relaxing effects and ability to mitigate some of the negative effects THC has on short-term memory. [24]

Conclusion

When looking at the evidence on the efficacy of medical cannabis for managing symptoms associated with MS (spasms, nerve pain, overactive bladder, insomnia, anxiety, depression), the overall picture is positive.

However, it must be noted that the evidence suggests [25] that medical cannabis helps manage spasms and pain in particular and that there is less robust and reliable evidence to support the use of cannabis for other symptoms associated with MS. Also, not all types of MS will respond to cannabis treatment, as not all types of MS have the same degree of neuroinflammation (e.g., primary progressive MS or PPMS). [26] More research is needed into what types and symptoms of MS medical cannabis can help manage.

References

[1] Torres-Moreno MC, Papaseit E, Torrens M, Farré M. ‘Assessment of Efficacy and Tolerability of Medicinal Cannabinoids in Patients With Multiple Sclerosis: A Systematic Review and Meta-analysis’. JAMA Netw Open. 2018;1(6):e183485. doi:10.1001/jamanetworkopen.2018.3485

[2] Brady CM, DasGupta R, Dalton C, Wiseman OJ, Berkley KJ, Fowler CJ. ‘An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis’. Mult Scler. 2004 Aug;10(4):425-33. doi: 10.1191/1352458504ms1063oa. PMID: 15327041.

[3] Rudroff T. Cannabis for Neuropathic Pain in Multiple Sclerosis-High Expectations, Poor Data. Front Pharmacol. 2019;10:1239. Published 2019 Oct 22. doi:10.3389/fphar.2019.01239

[4] Rapino C, Tortolani D, Scipioni L, Maccarrone M. ‘Neuroprotection by (endo)Cannabinoids in Glaucoma and Retinal Neurodegenerative Diseases’. Curr Neuropharmacol. 2018;16(7):959-970. doi:10.2174/1570159X15666170724104305

[5] Giacoppo S, Pollastro F, Grassi G, Bramanti P, Mazzon E. ‘Target regulation of PI3K/Akt/mTOR pathway by cannabidiol in treatment of experimental multiple sclerosis’. Fitoterapia. 2017 Jan;116:77-84. doi: 10.1016/j.fitote.2016.11.010. Epub 2016 Nov 25. PMID: 27890794

[6] Saito VM, Rezende RM, Teixeira AL. ‘Cannabinoid modulation of neuroinflammatory disorders’. Curr Neuropharmacol. 2012;10(2):159-166. doi:10.2174/157015912800604515

[7] NIDA. 2021, April 13. ‘What are marijuana’s long-term effects on the brain?’. Retrieved from https://nida.nih.gov/publications/research-reports/marijuana/what-are-marijuanas-long-term-effects-brain on 2023, February 15.

[8] Lah TT, Novak M, Pena Almidon MA, et al. ‘Cannabigerol Is a Potential Therapeutic Agent in a Novel Combined Therapy for Glioblastoma’. Cells. 2021;10(2):340. Published 2021 Feb 5. doi:10.3390/cells10020340

[9] Mecha M, Carrillo-Salinas FJ, Feliú A, Mestre L and Guaza C (2020). ‘Perspectives on Cannabis-Based Therapy of Multiple Sclerosis: A Mini-Review’. Front. Cell. Neurosci. 14:34. doi: 10.3389/fncel.2020.00034

[10] Modglin, Lindsay, ‘Multiple Sclerosis Statistics 2023’. Singlecare. January 23, 2023.

[11] Tafti D, Ehsan M, Xixis KL. Multiple Sclerosis. [Updated 2022 Sep 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499849/

[12] Haase S, Linker RA. ‘Inflammation in multiple sclerosis’. Ther Adv Neurol Disord. 2021 Apr 16;14:17562864211007687. doi: 10.1177/17562864211007687. PMID: 33948118; PMCID: PMC8053832.

[13] Haase S, Linker RA. ‘Inflammation in multiple sclerosis’. Ther Adv Neurol Disord. 2021 Apr 16;14:17562864211007687. doi: 10.1177/17562864211007687. PMID: 33948118; PMCID: PMC8053832.

[14] Chaudhuri A, Behan PO. ‘Multiple Sclerosis Is Not an Autoimmune Disease’. Arch Neurol. 2004;61(10):1610–1612. doi:10.1001/archneur.61.10.1610

[15] National MS Society, ‘About MS’. https://www.nationalmssociety.org/For-Professionals/Clinical-Care/About-MS. Retrieved on February 14, 2023.

[16] Atalay S, Jarocka-Karpowicz I, Skrzydlewska E. ‘Antioxidative and Anti-Inflammatory Properties of Cannabidiol’. Antioxidants(Basel). 2019;9(1):21. Published 2019 Dec 25. doi:10.3390/antiox9010021

[17] Kim-Fine S, Greenfield J, Chaput KH, Robert M, Metz LM. ‘Cannabinoids and bladder symptoms in multiple sclerosis’. Mult Scler Relat Disord. 2021 Sep;54:103105. doi: 10.1016/j.msard.2021.103105. Epub 2021 June 23. PMID: 34216995.

[18] Valeri A, Mazzon E. ‘Cannabinoids and Neurogenesis: The Promised Solution for Neurodegeneration?’. Molecules. 2021;26(20):6313. Published 2021 Oct 19. doi:10.3390/molecules26206313

[19] Oreja-Guevara C. ‘Clinical efficacy and effectiveness of Sativex, a combined cannabinoid medicine, in multiple sclerosis-related spasticity’. Expert Rev Neurother. 2012 Apr;12(4 Suppl):3-8. doi: 10.1586/ern.12.11. PMID: 22509985.

[20] Russo M, Naro A, Leo A, Sessa E, D’Aleo G, Bramanti P, Calabrò RS. ‘Evaluating Sativex® in Neuropathic Pain Management: A Clinical and Neurophysiological Assessment in Multiple Sclerosis’. Pain Med. 2016 Jun;17(6):1145-54. doi: 10.1093/pm/pnv080. Epub 2016 Jan 13. PMID: 26764336.

[21] Various, ‘Nabiximols’. Science Direct. Essentials of Pain Medicine (Fourth Edition), 2018.

[22] Rudroff T, Sosnoff J. ‘Cannabidiol to Improve Mobility in People with Multiple Sclerosis’. Front Neurol. 2018;9:183. Published 2018 Mar 22. doi:10.3389/fneur.2018.00183.

[23] Mesquita HL, Fontes LBA, Cinsa LA, Da Silva Filho AA, Nagato AC, Aarestrup BJV, Corrêa JOA, Aarestrup FM. ‘β-Caryophyllene causes remyelination and modifies cytokines expression in C57BL/6 mice with experimental autoimmune encephalomyelitis’. J Appl Pharm Sci, 2019; 9(07):027–033.

[24] Weston-Green K, Clunas H, Jimenez Naranjo C. ‘A Review of the Potential Use of Pinene and Linalool as Terpene-Based Medicines for Brain Health: Discovering Novel Therapeutics in the Flavours and Fragrances of Cannabis’. Front Psychiatry. 2021;12:583211. Published 2021 Aug 26. doi:10.3389/fpsyt.2021.583211

[25] Haddad F, Dokmak G, Karaman R. The Efficacy of Cannabis on Multiple Sclerosis-Related Symptoms. Life (Basel). 2022;12(5):682. Published 2022 May 5. doi:10.3390/life12050682

[26] National Multiple Sclerosis Society, ‘Primary Progressive MS (PPMS)’. Retrieved February 14, 2023.